Research: Fetal Surgery in the era of SARS-CoV-2 pandemic: A single institution review

Mayo Clin Proc Innov Qual Outcomes

. 2020 Aug 19. doi: 10.1016/j.mayocpiqo.2020.08.001. Online ahead of print.

Fetal Surgery in the era of SARS-CoV-2 pandemic: A single institution review

Kavita Narang 1Amro Elrefaei 1Michelle A Wyatt 1Lindsay L Warner 2Ayssa Teles Abrao Trad 1Leal G Segura 2Ellen Bendel-Stenzel 3Edward S Ahn 4Katherine W Arendt 2M Yasir Qureshi 5Rodrigo Ruano 1Affiliations expand

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Objectives: To cope with the changing healthcare services in the era of SARS-CoV-2 pandemic; we share the institutional framework for the management of anomalous fetuses requiring fetal intervention at Mayo Clinic, Rochester, Minnesota. To assess the success of our program during this time, we compare intraoperative outcomes of fetal interventions performed during the pandemic, with the previous year.

Patients: We implemented our testing protocol on patients undergoing fetal intervention at our institution between March 1st and May 15th 2020 and we compared to same period a year before. A total of 17 pregnant patients with anomalous fetuses who met criteria for fetal intervention were included; 8 from 2019 and 9 from 2020.

Methods: Our testing protocol was designed based on our institutional perinatal guidelines, surgical requirements from Infection prevention and control (IPAC) committee and input from our fetal surgery team; with focus on urgency of procedure and maternal SARS-CoV-2 screening status. We compared the indications, types of procedures, maternal age, gestational age at procedure, type of anesthesia used and duration of procedure for cases performed at our institution between March 1st, 2020 to May 15th, 2020 and the same period in 2019.

Results: There were no statistically significant differences between the number of cases, indications, types of procedures, maternal age, gestational age, types of anesthesia and duration of procedures (p values were all > 0.05) between pre-SARS-CoV-2 pandemic in 2019 and SARS-CoV-2 pandemic in 2020.

Conclusion: Adoption of new institutional protocols during SARS-CoV-2 pandemic, with appropriate screening and case selection, allows provision of necessary fetal intervention with maximum benefit to mother, fetus and health care provider.

Keywords: ACOG, American College of Obstetrics and Gynecology; AFPS, American foundation for patient safety; AGP, Aerosol generating procedures; ASA, American Society of Anesthesiology; CDH, Congenital diaphragmatic hernia; COVID-19; COVID-19, Coronavirus 2019; FETO, Fetoscopic endoluminal tracheal occlusion; Fetal intervention; GA, General anesthesia; IFMSS, International Fetal Medicine and Surgery society; LUTO, lower urinary tract obstruction; MAC, Monitored anesthesia care; NAFTNet, North American Fetal Therapy Network; OR, Operating room; SARS-CoV-2; SMFM, Society for Maternal and Fetal Medicine; TAPS, Twin anemia polycythemia sequence; TTTS, Twin to twin transfusion syndrome; WHO, World health organization; fetal anomalies; pregnancy; qRT-PCR, Quantitative real time polymerase chain reaction.

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