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Re: "EXIT" procedure- was- obstructed labour From: rmodugno@aol.com Mon Dec 31 14:44:31 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun: "Re: Sent from iPhone" Previous message: AllanHo@aol.com: "Re: obstructed labour" -----Original Message----- From: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. <johnprov@sympatico.ca> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> Sent: Sat, 29 Dec 2007 3:09 pm Subject: Re: obstructed labour At Sat, 29 Dec 2007, Dr Eberhard W Lisse wrote: > >I believe that once you cut the uterus, you have to get the baby out >expediciously. > >But probably there is some evidence about that. > >el > 4-5 minutes is expeditious enough, actually when in utero fetal surgery first caught started it was almost never done with fetuscopy so delievering a fetus less than 24 wks by c-section often classical operating on the feus and then placing it back in and then delievering 10 wks latter is not unheard of, the key of course was not cutting the placenta and hoping it would not separate. this was initially done with diaphragmatic hernias. Some babies made it some did not. -- Take care, John ****************************************** This also applies to the "EXIT" procedure - a section done when tracheal obstruction is anticipated - for example a large cystic hygroma. Have participated in one of these. The patient is placed under G.A. and halothane is given to relax the uterus - this "equilibration" lasts about twenty minutes - the uterus is then incised and the membranes are ruptured.The uterus does not contract (and hence the placenta does not detach), the baby's head and thorax are delivered, the baby is intubated while half in utero. If intubation is not possible, a tracheotomy is performed. Then the body is delivered, the cord (O2 supply) is cut and oxytocics are given. Exciting! The OR was really crowded that day - ob, perinatologist, anesthesiologist, neonatologist, pediatric ENT surgeon. Happy 2008 to all! Robert Modugno MD MBA FACOG Sylva, NC Next message: R. Daniel Braun: "Re: Sent from iPhone" Previous message: AllanHo@aol.com: "Re: obstructed labour"

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