J Korean Surg Soc.  2007 Feb;72(2):138-142.

An Experience of the Fetal Stabilization

• Kim HY
• Cho YH
• Park SE
• Kwon JY
• Lee DH

Abstract

PURPOSE: The authors applied fetal stabilization and evaluated its efficacy as a therapeutic modality in the management of several congenital anomalies that can lead to perinatal respiratory distress, such as a congenital diaphragmatic hernia (CDH), large cervical lymphangioma or gastroschisis, etc.
METHODS
Between Oct. 2000 and Dec. 2004, 12 newborns, with a congenital diaphragmatic hernia or gastroschisis, were observed and fetal stabilization was applied to 4 neonates. Their clinical characteristics were then retrospectively reviewed. The protocol of this procedure was as followed, (1) monitoring of the fetal respiratory movement and heart beat using Doppler ultrasonography, (2) the intravenous administration of morphine (20 to 30 mg) and diazepam (5 mg) to the mother, (3) proceed to a cesarean section when any interruptions in the fetal movement were confirmed, (4) an intravenous injection of a pancuronimum (0.5 mg) through the umbilical vein, (5) an immediate tracheal intubation before disruption of the placenta, (6) clamping of the umbilical cord, (7) attempt a mechanical ventilation after delivery, (8) maintain percutaneous intravenous catheterization (PIC) and (9) evaluation of the neonate.
RESULTS
Of the 10 neonates with a CDH and the 2 with gastroschisis, fetal stabilization was applied to 3 CDH and 1 gastroschisis neonates, respectively. The survival rates were 85.7% that of conventional therapy, 66.7% for fetal stabilization in the CDH neonates and 100% for those with gastroschisis. Relatively, in those with a CDH where fetal stabilization was applied, large defects were observed and they were diagnosed at an earlier period, which could affect the mortality.
CONCLUSION
In our experience, fetal stabilization seems to be useful as another alternative therapeutic modality for the control of respiratory distress in the management of a CDH and gastroschisis. However, further experiences with more clinical results will be required

Keyword

Fetal stabilization; Congenital diaphragmatic hernia; Gastroschisis

MeSH Terms

Administration, Intravenous
Catheterization
Catheters
Cesarean Section
Constriction
Diazepam
Female
Fetal Movement
Gastroschisis
Heart
Hernia, Diaphragmatic
Humans
Infant, Newborn
Injections, Intravenous
Intubation
Lymphangioma
Morphine
Mortality
Mothers
Placenta
Pregnancy
Respiration, Artificial
Retrospective Studies
Survival Rate
Ultrasonography, Doppler
Umbilical Cord
Umbilical Veins
Diazepam
Morphine