Fetal Surgery for Congenital Diaphragmatic Hernia Periprocedural Care

Updated: Jan 03, 2017
  • Author: Doug N Miniati, MD; Chief Editor: Hanmin Lee, MD  more...
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Periprocedural Care

Patient Education and Consent

The risks, benefits, and potential complications are thoroughly reviewed with the patient.

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Preprocedural Planning

Appropriate consultations are made with the pediatric surgeon, perinatologist, neonatologist, anesthesiologist, and social worker.

The patient is admitted to the obstetrical unit, and a baseline physical assessment is performed, including fetal heart rate and uterine contraction monitoring. The latest prenatal sonogram is reviewed and indications for surgery are confirmed.

Preoperative laboratory tests include a complete blood count (CBC), blood type and screen, and urinalysis. Activity is ad libitum, and bedrest exercises are reviewed.

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Patient Preparation

The patient is kept nil per os for 8 hours before surgery. Immediately before surgery, indomethacin for tocolysis may be administered, and perioperative antibiotics are given.

Depending on the surgeon's choice, anesthesia can range from local to locoregional to general.

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Monitoring & Follow-up

After the procedure, the patient is readmitted to the obstetrical unit for monitoring.

Daily ultrasonography and fetal echocardiography (if indicated) are performed. After the procedure on the day of surgery, the patient's diet is advanced as tolerated, and she remains in bed with lateral positioning. Owing to potential pulmonary edema, fluids are restricted to 3 L/day if the patient is treated with magnesium sulfate. Incentive spirometry and continuous pulse oximetry are instituted.

Fetal heart rate and uterine contractions are monitored until discontinued by the fetal treatment team. Tocolysis is achieved with indomethacin, magnesium sulfate, or nifedipine, as dictated by the fetal treatment team. On postoperative day 1, the patient is allow to ambulate, and a CBC is performed.

The patient is discharged when she is ambulatory, is tolerant of a diet, is spontaneously voiding, has good pain control with oral medications, is afebrile with normal vital signs and reassuring physical examination findings, and has a normal fetal heart rate and minimal uterine contractions. Oral tocolysis is continued as needed.

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