Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

3 results

  • Out-of-hours versus in-hours delivery of antenatally diagnosed transposition of the great arteries: outcomes from a United Kingdom Tertiary Centre

  • Daniel G.W. Cave, Peter J. Lillitos, Rebecca Lancaster, James R. Bentham, Shuba Barwick
  • Journal:
    Cardiology in the Young / Volume 33 / Issue 10 / October 2023
    Published online by Cambridge University Press:
    03 November 2022, pp. 1873-1878
    • Article
      • You have access
      • Open access
    • PDF
    • HTML
    • Export citation
  • Objective

    To study the impact of out-of-hours delivery on outcome for neonates with antenatally diagnosed transposition of the great arteries.

    Setting

    Tertiary paediatric cardiology centre (Yorkshire, United Kingdom), with co-located tertiary neonatal unit.

    Patients

    Neonates with antenatally diagnosed simple transposition of the great arteries delivered out-of-hours (Monday to Friday 17:00–08:00 and weekends) versus in-hours between 2015 and 2020.

    Outcome

    The primary outcome was survival to hospital discharge. Secondary outcomes included neurological morbidity, length of stay, and time to balloon atrial septostomy.

    Results

    Of 51 neonates, 38 (75%) were delivered out-of-hours. All neonates born in the tertiary centre survived to discharge. Time to balloon atrial septostomy was slightly longer for out-of-hours deliveries compared to in-hours (median 130 versus 93 mins, p = 0.33). Neurological morbidity occurred for nine (24%) patients in the out-of-hours group and one (8%) in-hours (OR 3.72, 95% CI: 0.42–32.71, p = 0.24). Length of stay was also similar (18.5 versus 17.3 days, p = 0.59). Antenatal diagnosis of a restrictive atrial septum was associated with a lower initial pH (7.03 versus 7.13; CI: 0.03–0.17, p = 0.01), longer length of stay (22.6 versus 17.3 days; CI: 0.37–10.17, p = 0.04), and increased neurological morbidity (44% versus 14%; OR 4.80, CI 1.00–23.15, p = 0.05). A further three neonates were delivered in surrounding hospitals, with a mortality of 67% (versus 0 in tertiary centre; OR 172, CI 5-5371, p = 0.003).

    Conclusion

    Neonates with antenatally diagnosed transposition of the great arteries have similar outcomes when delivered out-of-hours versus in-hours. Antenatal diagnosis of restrictive atrial septum is a significant predictor of worse outcomes. In our region, delivery outside the tertiary cardiac centre had a significantly higher risk of mortality.

  • Chapter 8 - Fetal Cardiac Intervention

  • from Section 2
  • Edited by Olutoyin A. Olutoye
  • Book:
    Anesthesia for Maternal-Fetal Surgery
    Published online:
    19 November 2021
    Print publication:
    11 November 2021, pp 103-118

  • Summary

    Fetal cardiac intervention provides fetuses with certain cardiac anomalies, a greater likelihood of biventricular circulation and/or treatment options after delivery. Anesthesia care for mothers undergoing fetal cardiac intervention has evolved over the years and more recently involves the use of neuraxial anesthesia with sedation. The maternal fetal anesthesiologist caring for the patient undergoing fetal cardiac intervention should be conversant with the diagnosis, pathophysiology, and planned intervention. This is important for appropriate anticipation and treatment of hemodynamic changes that may occur in the fetus immediately following intervention.

  • Chapter 11.4 - Twin-to-twin transfusion syndrome

  • from Section 2 - Fetal disease
  • Edited by Mark D. Kilby, Anthony Johnson, Baylor College of Medicine, Texas, Dick Oepkes
  • Book:
    Fetal Therapy
    Published online:
    05 February 2013
    Print publication:
    13 December 2012, pp 173-183

  • Summary

    This chapter discusses the twin-to-twin transfusion syndrome (TTTS) treatment options focusing on fetoscopic laser ablation of anastomoses. It also explains the benefits and risks associated with this treatment. Fetoscopic laser coagulation of placental vessels (FLCPV) is the only treatment addressing the pathophysiology of the syndrome as proven through a randomized controlled study against amnioreduction. Septostomy is based on a deliberate opening of the intertwin membrane with the needle in order to let the amniotic fluid flow freely between the two amniotic sacs. Even though two randomized trials have yielded similar survival rates between amnioreduction and septostomy, it has been abandoned by most teams. The superiority of laser treatment over amnioreduction was established through a randomized controlled study. The type of anesthesia has also evolved with time since the first interventions. Some teams still operate under general anesthesia although it is significantly associated with significant maternal morbidity.