Dr.Mehta's Hospitals - A case of Multidisciplinary team work to save a life - First time in Chennai
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(L- R) –Dr.Jayanthi,
Dr.Thirunavakarasu, Dr. Suresh, Dr.Lakshmi & Dr.Uma Ram
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Dr.Mehta's Hospitals - A case of Multidisciplinary team work to save a
life - First time in Chennai
Chennai: EX-utero Intrapartum Treatment (EXIT) is a
procedure that is used to deliver babies with a neck swelling or where ever a
difficult airway is anticipated due to a mass in the neck or upper chest. The
procedure preserves utero-placental gas exchange ie the baby continues to
receive oxygen and nutrients from the mother until an airway is established by
placing an endotracheal tube and lung ventilated with satisfactory oxygenation.
Mrs D who
was having antenatal care at Seethapathy Clinic & Hospital, had an
ultrasound for checking the growth of the baby in her 28th week and
this revealed a swelling on front of the neck of that baby possibly from the
thyroid gland. This swelling was large, restricted the baby’s swallowing
causing pressure effect on the neck of the developing baby and resulted in
increase of the fluid around the baby.
A
detailed work up was done by the Fetal Medicine team at Mediscan Systems, and
by testing the fluid around the baby and blood sampling, it was confirmed that
the swelling was an enlargement of the fetal thyroid gland due to
hypothyroidism. The baby was treated in utero. Two injections were given
into the amniotic fluid at an interval of 2 weeks which showed improvement in
the level of the thyroid hormones in the fetus. This also helped to reduce the
amount of amniotic fluid and a small reduction in the size of the thyroid
swelling.
At 36
weeks a fetal MRI was done which showed compression of the trachea (airway)
which would make it difficult for the baby to breathe if it was delivered. Anticipating problems in securing
airway an EXIT procedure was planned at Dr. Mehta’s Hospitals.
The details were discussed with the parents and
family and after explaining the need for an elective caesarean with EXIT
procedure and possible problems, informed consent was obtained.
The multidisciplinary team of fetal medicine,
obstetricians, neonatologist, anesthetists, paediatric ENT, paediatric surgeons
and theatre staff came together and planned for the procedure. A mock
drill was done the day prior with the entire team
The maternal team included the anesthetist,
Obstetrician and fetal medicine. They needed to keep the mother under general
anesthesia and keep the uterus relaxed at the same time keep the placental
circulation going till the procedure on the baby is over.
The multi-disciplinary team involving a
neonatologist, pediatric anaethetist, pediatric ENT Surgeon, Pediatric surgeon
in case a surgical resection of the mass is required for the baby was the key.
Ideal positioning of each team with assistants and necessary equipments were
kept ready so that there is enough room for everybody to perform once their
turn comes.
A caesarean section was performed under general
anesthesia, the baby was delivered only upto the head and held in position with
the body still in the uterus with intact umbilical cord. An attempt to
intubate the airway with a tube to make an air passage for breathing was
attempted. As we were not able to visualize vocal cords, under bronchoscopic
guidance airway was secured by the team, after the airway was secured, the baby
was delivered and then the cord was cut.
The Baby needed ventilator support for 2 days. In
the meanwhile baby’s blood drawn for thyroid function tests and
oral thyroid hormone replacement started. With that the swollen
gland started shrinking well, the baby was taken off the endotracheal tube and
ventilation on day 3. Baby was able to breath easily without difficulty.
The
neonatal team from Dr. Mehta’s Hospitals was Dr Lakshmi, Dr Jayanthi, Dr
Thirunavukarasu, Dr. Balamurugane.
The
obstetric team from Seethapathy Hospital Dr Sowmya Balakrishnan, Dr. Uma Ram,
Dr Vasanthi Vidyasagar and Fetal medicine Specialist Dr S Suresh and Dr
Sudarshan Suresh from Mediscan.
The
following doctors can be contact for the further detail:
Dr.Jayanthi- 9791170840, Dr.Uma Ram – 98410
41267, Dr.Thirunavakkarasu – 98843 50280
For
further details and proceedings Mr. Immanuel S, Vice
President -9840095010.
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