Application of a fetal scalp electrode for continuous fetal heart rate monitoring during an ex utero intrapartum treatment

Kaneko, Masatoki; Tokunaga, Shunichi; Motoi, Mukai; Machigashira, Seirou; Maki, Youhei; Kodama, Yasuo; Sameshima, Hiroshi; Ikenoue, Tsuyomu

doi:10.1016/j.jpedsurg.2010.10.026

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…The administration of fentanyl directly to the fetus is reserved for cases with a minimal risk of fetal movements, such as in EXIT procedures, in which utero-placental perfusion is maintained until the fetal airway and ventilation are established. Consequently, the fetus is partly removed from the uterus, for example, in surgeries for laryngeal atresia, cervical teratoma, and cystic hygroma [14]. …”

Section: Discussionmentioning

confidence: 99%

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Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Santana¹,

Moron²,

Barbosa³

et al. 2015

Fetal Diagn Ther

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Objective: The aim of this study was to assess fetal hemodynamics during intrauterine open surgery for myelomeningocele (MMC) repair by describing fetal heart rate (FHR) monitoring in detail related to each part of the procedure. Methods: A study was performed with 57 fetuses submitted to intrauterine MMC repair between the 24th and 27th week of gestation. Evaluations of FHR were made in specific periods: before anesthesia, after anesthesia, at the beginning of laparotomy, during uterus abdominal withdrawal, hysterotomy, neurosurgery (before incision, during early skin manipulation, spinal cord releasing, and at the end of neurosurgery), abdominal cavity reintroduction, and abdominal closure, and at the end of surgery. Means ± standard deviations of FHR were established for each period, and analysis of variance with repeated measures was used to assess differences between these periods. The mean differences were assessed with 95% confidence intervals and were analyzed by Tukey's multiple comparison test. Results: The mean FHR during the specific periods mentioned above was 140.2, 140, 139.2, 138.8, 135.1, 133.9, 123.1, 134.0, 134.5, 137.9, and 139.9 bpm, respectively (p < 0.0001). Comparing the different periods, the highest frequencies were observed in the initial and final moments. The neurosurgery stage presents lower frequencies, especially during the release of the spinal cord. Conclusion: FHR monitoring revealed interesting findings in terms of physiological fetal changes during MMC repair, especially during neurosurgery, which was the most critical period.

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Section: Discussionmentioning

confidence: 99%

“…In 2011, Kaneko et al [14] reported a case of airway clearance by cervical teratoma in an open surgery with EXIT, in which FHR monitoring was performed by placing the electrode on the fetal scalp. The researchers were convinced that this method permitted an immediate approach to bradycardia caused by spinal compression.…”

Section: Discussionmentioning

confidence: 99%

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Santana¹,

Moron²,

Barbosa³

et al. 2015

Fetal Diagn Ther

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“…MFA was provided in 1,551 procedures from 59 studies ( 12 , 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , 83 , 85 , 86 , 88 , 95 , 98 , 100 , 104 , 106 , 108 , 112 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 172 , 176 , 177 ). Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 ,…”

Section: Resultsmentioning

confidence: 99%

Anesthesia for fetal operative procedures: A systematic review

et al. 2022

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ObjectiveThe anesthetic management of fetal operative procedures (FOP) is a highly debated topic. Literature on fetal pain perception and response to external stimuli is rapidly expanding. Nonetheless, there is no consensus on the fetal consciousness nor on the instruments to measure pain levels. As a result, no guidelines or clinical recommendations on anesthesia modality during FOP are available. This systematic literature review aimed to collect the available knowledge on the most common fetal interventions, and summarize the reported outcomes for each anesthetic approach. Additional aim was to provide an overall evaluation of the most commonly used anesthetic agents.MethodsTwo systematic literature searches were performed in Embase, Medline, Web of Science Core Collection and Cochrane Central Register of Controlled Trials up to December 2021. To best cover the available evidence, one literature search was mostly focused on fetal surgical procedures; while anesthesia during FOP was the main target for the second search. The following fetal procedures were included: fetal transfusion, laser ablation of placental anastomosis, twin-reversed arterial perfusion treatment, fetoscopic endoluminal tracheal occlusion, thoraco-amniotic shunt, vesico-amniotic shunt, myelomeningocele repair, resection of sacrococcygeal teratoma, ligation of amniotic bands, balloon valvuloplasty/septoplasty, ex-utero intrapartum treatment, and ovarian cyst resection/aspiration. Yielded articles were screened against the same inclusion criteria. Studies reporting anesthesia details and procedures’ outcomes were considered. Descriptive statistical analysis was performed and findings were reported in a narrative manner.ResultsThe literature searches yielded 1,679 articles, with 429 being selected for full-text evaluation. A total of 168 articles were included. Overall, no significant differences were found among procedures performed under maternal anesthesia or maternal-fetal anesthesia. Procedures requiring invasive fetal manipulation resulted to be more effective when performed under maternal anesthesia only. Based on the available data, a wide range of anesthetic agents are currently deployed and no consistency has been found neither between centers nor procedures.ConclusionsThis systematic review shows great variance in the anesthetic management during FOP. Further studies, systematically reporting intraoperative fetal monitoring and fetal hormonal responses to external stimuli, are necessary to identify the best anesthetic approach. Additional investigations on pain pathways and fetal pain perception are advisable.

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“…Fetal monitoring includes observing the color of the neonate, cord pulsations, precordial stethoscope, fetal scalp electrodes,[ 35 ] umbilical cord blood gases,[ 17 36 ] continuous fetal Doppler, transthoracic echocardiography,[ 20 ] and transesophageal echo cardiography. Pulse oximeters employing Masimo technology (reflectance oximetry) are invaluable for monitoring fetal oxygenation as they are devoid of movement artifacts.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Role of anesthesiologist in ex utero intrapartum treatment procedure: A case and review of anesthetic management

Subramanian

Mishra

Subramaniam

et al. 2018

J Anaesthesiol Clin Pharmacol

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Application of a fetal scalp electrode for continuous fetal heart rate monitoring during an ex utero intrapartum treatment

Cited by 9 publications

References 6 publications

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair

Anesthesia for fetal operative procedures: A systematic review

Role of anesthesiologist in ex utero intrapartum treatment procedure: A case and review of anesthetic management

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