A rare, life-saving operation performed with a baby still attached to the placenta was carried out at Sheba Medical Center, Tel Hashomer this weekend.
The mother, in her 30th week of pregnancy, had been diagnosed by doctors at Haemek Hospital in Afula as having excess amniotic fluid; the fetus had a life-threatening blockage in his breathing passages. Haemek sent her to Sheba for further treatment.
Normally, babies are operated on only after they are born. But because doctors at Sheba feared this baby would die before that, they decided to try a complicated procedure that has been described in the literature, but actually carried out only a handful of times over the last decade, all at major Western hospitals.
The doctors performed a Caesarean section and when the baby's head and shoulders emerged, "We checked his throat with an endoscopic device with a camera, inserted via the mouth, to see if it would be possible to insert a breathing tube," said Prof. Michael Wolf, head of Sheba's ear, nose and throat department.
When that didn't work, doctors extracted one of the baby's arms from the womb so as to inject an anesthetic. Then he was removed for a tracheostomy: a surgical procedure that opens a breathing hole in the neck. But throughout, the baby remained attached to his mother's placenta via the umbilical cord, to keep him breathing until he could do so on his own.
This procedure, known as an extrauterine, intrapartum treatment (EXIT) - i.e., an operation outside the womb while the birth is in process - is extremely rare, says Prof. Eyal Schiff, head of Sheba's gynecology and maternity center. In this case, the fetus' condition required the procedure, he said.
Altogether 30 medical staffers participated, including 10 doctors from different specialties. The entire operation took only 12 minutes - thanks in part to a "dress rehearsal" by the medical staff beforehand.
"It's not possible to keep the baby out of the womb for long, for fear that the flow of blood will weaken, the womb will contract and the placenta will start to separate," explained Schiff. "The baby and mother received anesthetics and medications to keep the placenta attached as much as possible, so the baby would ... get oxidized blood from his mother during the operation."
The baby is in stable condition in Sheba's neonatal intensive care unit.
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