title: Multidisciplinary perinatal management of the compromised airway on placental support: lessons learned.
abstract: OBJECTIVE
  The aims of this study were to review fetal and maternal outcomes after management of the compromised perinatal airway via operation on placental support or ex utero intrapartum treatment and to discuss implications for future management of these complex and rare cases.
  
  
  METHODS
  We have presented a retrospective case series of 12 neonates requiring airway management on placental support at a single tertiary care, academic center.
  
  
  RESULTS
  One mother experienced significant blood loss. Operative recovery times were unremarkable. Eight neonates required airway management due to mass obstruction, two for removal of an endotracheal balloon for fetoscopic treatment of congenital diaphragmatic hernia, one for laryngeal atresia, and one for severe retrognathia. One of our series is an unusual case of management on placental support after vaginal delivery. Another child would have ideally been managed on placental support, but an extremely short umbilical cord prevented this. Even though the airway was secured in all 12 cases, five neonates died in the perinatal period.
  
  
  CONCLUSIONS
  These procedures have a risk for substantial maternal blood loss. Despite excellent rates of success securing the neonatal airway, children who require management on placental support still have high mortality. A formalized multidisciplinary approach at our institution has enhanced preparedness for these cases.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Osborn
authors.forename: David
authors.initials: D
authors.lastname: Baud
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Macarthur
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Propst
authors.forename: Vito
authors.initials: V
authors.lastname: Forte
authors.forename: Susan M
authors.initials: SM
authors.lastname: Blaser
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.forename: Gareth
authors.initials: G
authors.lastname: Seaward
authors.forename: Johannes
authors.initials: J
authors.lastname: Keunen
authors.forename: Prakesh
authors.initials: P
authors.lastname: Shah
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
authors.forename: Paolo
authors.initials: P
authors.lastname: Campisi
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000151:congenital / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy; D033183:Interdisciplinary Communication; D008021:Life Support Systems; D010348:Patient Care Team; D018743:Perinatal Care / Q000379:methods / Q000458:organization & administration*; D010920:Placenta; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult