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Cesarean Section To Immediate Neonatal Intervention: A Multidisciplinary Approach To The Perinatal Care Of a Pregnancy Complicated By a Fetal Airway Obstruction
Title: Cesarean Section To Immediate Neonatal Intervention: A Multidisciplinary Approach To The Perinatal Care Of a Pregnancy Complicated By a Fetal Airway Obstruction
- Discuss the pathophysiology of fetal oropharyngeal teratomas
- Describe the multidisciplinary, perinatal management of a patient whose pregnancy is complicated by a prenatally diagnosed oropharyngeal teratoma, including EXIT procedure
- Identify the psychosocial needs of and resources available to a family experiencing a prenatally diagnosed airway obstruction
Oropharyngeal teratomas (epignathus) are rare (1:35,000-200,000) tumors composed of all three germ cell layers. They grossly appear as heterogeneous masses with solid and cystic components and are believed to result from a migration and entrapment of mesoderm and endoderm with ectoderm during embryogenesis of the oral cavity. Fetuses diagnosed with oropharyngeal teratomas are at risk of life-threatening airway obstruction necessitating the establishment of a stable airway, usually with a tracheostomy, while on placental bypass during an EXIT procedure or within minutes of birth. Polyhydramnios, preterm labor and preterm delivery are additional risk factors. This case study will review the multidisciplinary perinatal care of a pregnant woman whose fetus was diagnosed with an oropharyngeal teratoma.
Case:
This patient was a 32yo G3P1011, woman who presented for initial evaluation at 25w2d weeks. A large mass, originating from the base of the tongue and protruding from the mouth with a volume of 16.5ml, was seen on imaging studies. Mild polyhydramnios was present with an AFI of 24 cm. Weekly ultrasounds assessed the increasing size of the teratoma and amniotic fluid index. Delivery via an EXIT procedure was scheduled for 35 weeks gestation. At 32w5d weeks, the patient presented with an AFI of 48cm and maternal complaints related to the polyhydramnios. An amnioreduction was performed for 2000mls. During fetal monitoring post procedure, late decelerations were noted and the patient underwent a stat C/Section for placental abruption. A tracheostomy was performed within minutes of delivery and the baby was subsequently transferred to the NICU.
Conclusion:
Nurses were ideally suited to provide family centered and holistic care to this patient and her family. Nurses with varying areas of expertise participated in the care of this patient and her family in both the outpatient and inpatient settings. Throughout the pregnancy continuum, nurses were the primary source of clinical care, education and psychosocial support for this patient and her family. Timely, articulate communication between nurses at the time of the cesarean delivery facilitated the rapid assembly of the multidisciplinary team and the procurement of the required instruments from the main perioperative area allowing for immediate successful, neonatal intervention.
Keywords: oropharyngeal teratoma, EXIT procedure, fetal airway obstruction, fetal anomaly