Fetal airway management on placental support: Limitations and ethical considerations in seven cases

Barthod, G; Teissier, Natacha; Bellarbi, N; Viala, P.; Oury, Jean‐François; Dray, Géraldine; Vuillard, E.; Michel, Julie; Abbeele, Thierry Van Den

doi:10.3109/01443615.2013.823924

Cited by 23 publications

(21 citation statements)

References 18 publications

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“…In fetuses with masses of the face and neck, the largest measurement of the vertical pocket and mass effect on the trachea had the greatest contribution to the prediction of significant morbidity 11 . In all cases with a high suspicion of upper airway obstruction, the EXIT procedure should be performed 11,23,25–27 . In our series, the 2 cases diagnosed with LM with polyhydramnios were delivered via the EXIT procedure.…”

Section: Discussionmentioning

confidence: 82%

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Prenatal Diagnosis of Fetal Oral Masses by Ultrasound Combined With Magnetic Resonance Imaging

Yan

Shentu

et al. 2021

J of Ultrasound Medicine

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Objectives-To analyze the imaging manifestations of common fetal oral masses by ultrasound combined with magnetic resonance imaging (MRI) and to discuss their differential diagnoses.Methods-A retrospective study of 6 fetuses with oral masses was performed at a tertiary referral center. The imaging features of prenatal ultrasonography and MRI in the diagnosis of fetal oral masses were analyzed.Results-Histopathological examination and/or postpartum ultrasound revealed lymphangioma malformation in 2 fetuses, and mucosal retention cyst, mature teratoma, immature teratoma, and cranial meningocele in 1 fetus, respectively. The teratoma had a characteristic sonographic appearance. In our study, the 4 cases of cystic masses did not have an abnormal vessel architecture. Supplemental MRI revealed a mass effect at the level of the hypopharynx, and in 2 cases with polyhydramnios, the mass obstructed the fetuses' upper airway. Thus, exutero intrapartum therapy surgery was performed to secure the newborn's airway.Conclusions-Oral fetal tumors represent rare congenital malformations. This study shows that a prenatal diagnosis of oral masses is feasible by ultrasound examination. MRI can further confirm the results of ultrasonography and clearly show the relationship between the mass and the hypopharynx. Ultrasonography combined with MRI could, to a large extent, facilitate early detection and appropriate treatment and improve outcome.

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Section: Discussionmentioning

confidence: 82%

“…11 In all cases with a high suspicion of upper airway obstruction, the EXIT procedure should be performed. 11,23,[25][26][27] In our series, the 2 cases diagnosed with LM with polyhydramnios were delivered via the EXIT procedure. Treatment of LM has typically been managed with sclerotherapy, laser therapy, or surgery for localized lesions.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis of Fetal Oral Masses by Ultrasound Combined With Magnetic Resonance Imaging

Yan

Shentu

et al. 2021

J of Ultrasound Medicine

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“…This has sometimes been due to compression by cervical teratomas or other tumours. [9] While CHAOS is a further indication for this method of intervention, there are few reported cases in the literature where EXIT procedure followed by intubation or tracheostomy has been performed for this indication with successful outcome. [2,5,7,8,[10][11][12][13] With advances in imaging technology, CHAOS can be diagnosed relatively easily antenatally by ultrasound findings of enlarged echogenic lungs, eversion of the diaphragm and tracheal dilatation, as was the case in our patient.…”

Section: Discussionmentioning

confidence: 99%

Medicine and the Law

et al. 2022

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Congenital high airway obstruction syndrome (CHAOS) is a rare condition that can be diagnosed antenatally by ultrasound. It is usually lethal without immediate intervention at delivery. A 24-year-old woman was diagnosed with fetal CHAOS at 27 weeks’ gestation. The couple declined termination of pregnancy. A multidisciplinary team including obstetricians, geneticists, paediatric surgeons, neonatologists and anaesthetists was constituted to plan an ex utero intrapartum treatment (EXIT) procedure. After several simulations, a caesarean section was performed at 38 weeks’ gestation under deep inhalational anaesthesia. The fetus was fully delivered with placenta remaining in utero to maintain perfusion. A surgical airway was established via tracheostomy in approximately 5 minutes. The operation was then completed with no maternal complications. The child remains well at 3 years of age. To our knowledge, this is the first EXIT procedure performed for CHAOS in the public sector. This procedure can be lifesaving and is possible with proper planning.

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“…While the EXIT procedure has been shown to benefit infants with prenatal airway compromise, it is not without risks to the mothers (21)(22)(23). The EXIT procedure requires mothers to receive general anesthesia and agents to promote uterine relaxation in order to maintain placental support for the fetus.…”

Section: Prenatal and Perinatal Interventionmentioning

confidence: 99%

Congenital cervical teratoma in association with neuronal migration disorder

Mary¹

2017

JPM

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Congenital cervical teratoma is a rare congenital malformation with an estimated incidence of one in 20,000-40,000 live births. Due to its mass effect it has a potential to cause significant fetal airway obstruction, while its hyper-vascularity may result in fetal heart failure and hydrops fetalis. An association with intracranial abnormalities has been previously described but is extremely rare and no cases of postnatal survival have previously been reported. In this study we report the first case of congenital cervical teratoma with neuronal migration disorder in a live-born infant and the role of in-utero cyst drainage as an airway salvage intervention. We also present a literature review on etiology, diagnosis, management options and prognosis of congenital cervical teratoma with and without intracranial abnormalities.

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Fetal airway management on placental support: Limitations and ethical considerations in seven cases

Cited by 23 publications

References 18 publications

Prenatal Diagnosis of Fetal Oral Masses by Ultrasound Combined With Magnetic Resonance Imaging

Prenatal Diagnosis of Fetal Oral Masses by Ultrasound Combined With Magnetic Resonance Imaging

Medicine and the Law

Congenital cervical teratoma in association with neuronal migration disorder

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