Types of procedures
All FTCs surveyed offer labor and delivery services and perform minimally invasive fetal interventions.
Annual number of minimally invasive procedures:
- 14 FTCs performed < 25
- 11 FTCs performed 26 to 75
- 8 FTCs performed 75 to 150
Of the FTCs surveyed, 30 perform EXIT procedures:
- All used general endotracheal anesthesia (GETA)
- 3 first attempted with neuraxial anesthesia and converted to GETA if the case required additional uterine relaxation with a volatile anesthetic
- Annual number of EXIT procedures:
- 18 FTCs performed 1 to 2
- 10 FTCs performed 3 to 5
- 2 FTCs performed 6 to 10
Of the FTCs surveyed, 20 perform open mid-gestation fetal surgeries:
- All reported performing open myelomeningocele repairs
- All reported using GETA
- Annual number of open mid-gestation fetal surgeries:
- 2 FTCs performed 1 to 2
- 7 FTCs performed 3 to 5
- 3 FTCs performed 6 to 10
- 6 FTCs performed 11 to 20
- 2 FTCs performed > 20 cases
FTCs that perform open fetal surgeries vs. those that do not
FTCs that perform open fetal surgeries are more likely to be directed by a pediatric surgeon and perform more than 25 minimally invasive procedures
Discussion: most common fetal surgery was minimally invasive
This is the first known formal survey of FTCs in the NAFTNet consortium to evaluate anesthesia staffing models and anesthetic techniques for fetal interventions.
Minimally invasive fetal interventions were the most commonly performed:
- All FTCs performed ultrasound-guided fetal interventions
- Almost all FTCs performed fetoscopic interventions
- The majority of FTCs performed ≤ 75 minimally invasive fetal interventions annually
- Almost half of the FTCs performed ≤ 25 minimally invasive fetal interventions annually
EXIT cases are rare:
- The majority of FTCs performed EXIT procedures
- > 90% of FTCs performed <5 EXIT procedures annually
- Almost half of FTCs used multiple subspecialty trained anesthesiologists
- 79% of FTCs used both obstetric and pediatric anesthesiologists
Open mid-gestation fetal surgeries likely benefit from multidisciplinary anesthesiology approach:
- 61% of FTCs performed open mid-gestation fetal surgeries
- 90% of FTC performed <10 annually
- 55% of FTCs used multiple anesthesiology subspecialists
- 82% of FTCs used both obstetric and pediatric anesthesiologists
When comparing FTCs that perform open fetal surgeries with those that do not, only two significant differences were found: FTCs performing open fetal surgeries are more likely to be directed by a pediatric surgeon, and these FTCs perform more minimally invasive fetal interventions.
Conclusions: there is a varied approach to fetal surgery amongst the centers
There is considerable variability in the anesthesia staffing, caseload and anesthetic techniques used across FTCs in NAFTNet. Most FTCs used maternal sedation for minimally invasive procedures and general anesthesia for EXIT and open fetal surgeries.
This survey is the first step toward developing standards and improving maternal and fetal anesthetic care in these complex cases.
Read the full study, published in the April 7, 2021 version of Fetal Diagnosis and Therapy.