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Fetal Surgery and Procedures Updated 4/2010

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BASICS

  • Description
  • Associated Conditions

TREATMENT

  • Pregnancy Specific Issues
  • Surgery

Ongoing Care

  • Disposition
  • Prognosis
  • Complications
The following is an excerpt....
BASICS
Description
  • Placement of fetal shunt:
    • A shunt allows drainage of the malformation into the amniotic cavity.
  • Fetoscopy:
    • Trocar is placed in the amniotic cavity under direct US guidance.
    • Fetal diagnosis or intervention is performed with direct visualization.
    • Fetoscopic laser ablation is used to treat twin-twin transfusion syndrome (see topic).
  • Open fetal surgery:
    • Uterus is exposed and direct access to amniotic cavity is gained through uterine incision.
  • EXIT procedure:
    • High-risk fetus is delivered by cesarean section; prior to delivery the fetal airway and/or venous access is obtained while utero placental gas exchange is preserved.
  • Fetal cardiac procedures:
    • Percutaneous transthoracic pacemakers can be placed for fetal arrhythmias. (Note: Currently limited success with this technique.)
    • Open fetal surgery has ...

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See Also
Images >
123
FIGURE 107.4 Fetal surgery of a hydropic 24-week fetus with a large left lung mass. (A) Intraoperative ultrasound to locate the placenta and fetus. (B) Uterine stay sutures are elevated to facilitate the use of the uterine stapler. (C) The mass has been removed and the remaining normal left lung is evident. A bolus of crystalloid is given into the umbilical vein, and the chest is being closed.Credit: Michael W. Mulholland, Ronald V. Maier etal. Greenfield's Surgery Scientific Principles And Practice, Fourth Edition. Philadelphia: Lippincott Williams & Wilkins, 2006.
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