Intrapartum management of severe fetal airway obstruction.
OBJECTIVE
To review our experience with the planned intrapartum management of fetuses with suspected severe airway obstruction.


METHODS
Retrospective review of prenatal presentations, intrapartum airway procurement methods, outcomes, and complications.


RESULTS
All cases (N = 11) at our tertiary airway referral institution between 1995 and 2002 were reviewed. Obstruction was secondary to giant cervicofacial lymphangiomas (5), teratomas (2), epignathis (1), epulis (1), conjoined fetus (1), and tracheal foreign body (1). Elective cesarean delivery of the entire fetus was performed while maintaining fetal-placental circulation as long as possible. We found it necessary to deliver the entire fetus to improve airway exposure and decrease maternal hemorrhage. The airway was secured effectively in all cases.


CONCLUSIONS
Although full cesarean delivery of the fetus significantly reduces fetal-placental circulation times, in comparison with the formal ex utero intrapartum treatment (EXIT) procedure, airway access is improved, maternal complications may be decreased, and high airway procurement success is still safely achieved.
Preciado
Diego A
DA
Department of Pediatric Otolaryngology, 3333 Burnet Avenue, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Rutter
Michael J
MJ
Greenberg
James M
JM
Bahado-Singh
Ray
R
Lambers
Donna
D
Willging
J Paul
JP
D000402:Airway Obstruction / Q000601:surgery*; D001999:Bronchoscopy; D002585:Cesarean Section; D005153:Facial Neoplasms / Q000601:surgery; D005260:Female; D005315:Fetal Diseases / Q000601:surgery; D005547:Foreign Bodies / Q000601:surgery; D005882:Gingival Diseases / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods; D017214:Laryngeal Masks; D007828:Laryngoscopy; D008202:Lymphangioma / Q000601:surgery; D010157:Palatal Neoplasms / Q000601:surgery; D021041:Placental Circulation / Q000502:physiology; D011247:Pregnancy; D012189:Retrospective Studies; D013724:Teratoma / Q000601:surgery; D014132:Trachea; D014140:Tracheotomy; D016896:Treatment Outcome; D014428:Twins, Conjoined