Jose Peiro

99 statements · 2 topics

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Open fetal surgery still is used for large, solid masses in the chest, for sacrococcial teratomass, and also for spina bifida.

quote · Congenital Pulmonary Airway Malformation

Open fetal surgery is the gold standard for spina bifida, though other innovations are in development.

guideline · Congenital Pulmonary Airway Malformation

The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia.

clinical · Fetal Surgery

During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate.

clinical · Fetal Surgery

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Jose's statements about Congenital Pulmonary Airway Malformation 33 statements

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Open Fetal Surgery & EXIT Procedure with Dr. Jose Peiro

Quotation The answer is very easy. It's just because we have prenatal diagnosis. Open

Quotation So in other words, we can detect things in utero very early in gestation. Open

Statement Prenatal ultrasound at mid-gestation around 20 weeks is the best tool for detecting fetal malformations, with high detection rates in developed countries. Open

Quotation The most important is the prenatal ultrasounds. The conventional ultrasounds at mid gestation around 20 weeks will be the best. Open

Statement Doppler ultrasound can assess fetal hemodynamic status by measuring flows in the umbilical artery, ductus venosus, and middle cerebral artery. Open

Statement Fetal MRI contributes to diagnosis definition after ultrasound, especially for findings in the brain, chest, and abdomen. Open

Quotation So that's the goal of fetal intervention. Just try to rescue or improve these conditions. Open

Statement In gastroschisis, earlier delivery can reduce bowel injury, resulting in less serositis and better recovery. Open

Quotation Open fetal surgery is the most similar to neonatal surgery, so we have the patient in our hands. We can operate in a fetus the same as we operate in a preemie. Open

Quotation The only problem is we need to open the uterus. Open

Quotation For that reason, all the fetal surgeons were trying to go away from fetal surgery, trying to look for minimally invasive surgery. Open

Statement Open fetal surgery is still used for large solid chest masses, sacrococcygeal teratomas, and spina bifida. Open

Quotation Open fetal surgery still is used for large, solid masses in the chest, for sacrococcial teratomass, and also for spina bifida. Open

Statement Solid CPAM lesions grow rapidly and can cause mediastinal shift, compression of the contralateral lung and heart, leading to hydrops fetalis. Open

Statement Hydrops fetalis (ascites, pleural effusion, scalp edema, anasarca) is very close to fetal demise and is the usual outcome if untreated. Open

Quotation So hydros fetalis is very close to be complete a fetal demise. That is the usual outcome of these babies if we don't do nothing. Open

Quotation Everything that measures less than 1.6 is very, very low risk of developed eye drops. On the contrary, more than 1.6, we have high risk of eye drops and complications. Open

Statement CVR less than 1.6 indicates very low risk of hydrops; CVR greater than 1.6 indicates high risk of hydrops and complications. Open

Quotation It's a good rescue in more than half of these babies. So, the other half or 40%, probably don't respond very well. Open

Statement Steroids rescue more than half of CPAM cases; the remaining 40% do not respond well. Open

Statement Before 30 weeks, cystic CPAM can be treated with a shunt; solid CPAM requires open fetal surgery and lobectomy. Open

Statement Solid sacrococcygeal teratomas are more dangerous than cystic ones due to rapid growth and vascularization visible on Doppler. Open

Statement The Altman classification used postnatally can also be applied to prenatal MRI to determine teratoma type and need for intervention. Open

Statement Open fetal surgery is the gold standard for spina bifida, though other innovations are in development. Open

Statement Spina bifida originates at approximately 4 weeks of embryonic time when the neural tube fails to close. Open

Statement In spina bifida, the exposed spinal cord is damaged by contact with amniotic fluid rich in meconium and enzymes (the 'second hit'), progressively destroying neural tissue and nerves. Open

Statement Hydrocephalus in spina bifida requires ventriculoperitoneal shunting and causes migration disorders and heterotopia. Open

Statement The rationale for fetal spina bifida repair is to prevent amniotic fluid from touching the nerves and to stop CSF leak. Open

Statement In fetoscopic spina bifida repair, a collagen patch is introduced through the cannula for duroplasty, maintained with one stitch, followed by primary skin closure or patch. Open

Statement The EXIT procedure is performed at delivery for conditions that can cause neonatal asphyxia or difficult intubation, such as neck masses compressing the trachea, congenital airway obstruction, or severe micrognathia. Open

Statement During EXIT, placental oxygenation can be maintained for 1 to 3 hours, providing a controlled situation without need to rush airway securement. Open

Statement During EXIT for neck teratomas, if intubation is not possible with rigid instruments or laryngoscopy, partial resection of the teratoma can be performed to identify the trachea and then intubate. Open

Statement Once intubation is achieved during EXIT, the cord is clamped and complete teratoma resection is performed in an adjacent operating room. Open

Jose's statements about Fetal Surgery 66 statements

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