Fetal Surgery in the Era of SARS-CoV-2 Pandemic: A Single-Institution Review

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

doi:10.1016/j.mayocpiqo.2020.08.001

Fetal Surgery in the Era of SARS-CoV-2 Pandemic: A Single-Institution Review

Mayo Clin Proc Innov Qual Outcomes. 2020 Dec;4(6):717-724. doi: 10.1016/j.mayocpiqo.2020.08.001. Epub 2020 Aug 19.

Affiliations

¹ Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN.
² Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN.
³ Division of Neonatology, Department of Pediatrics and Adolescent medicine, Mayo Clinic College of Medicine, Rochester, MN.
⁴ Division of Neurosurgery, Department of Pediatrics and Adolescent medicine, Mayo Clinic College of Medicine, Rochester, MN.
⁵ Pediatric Cardiology Division, Department of Pediatrics and Adolescent medicine, Mayo Clinic College of Medicine, Rochester, MN.

Abstract

Objective: To cope with the changing health care 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 1, and May 15, 2020, and we compared it with 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 the 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 1, 2020, and May 15, 2020, and for the same period in 2019.

Results: There were no statistically significant differences among the number of cases, indications, types of procedures, maternal age, gestational age, types of anesthesia, and duration of procedures (P values were all >.05) between the pre-SARS-CoV-2 pandemic in 2019 and the SARS-CoV-2 pandemic in 2020.

Conclusions: Adoption of new institutional protocols during SARS-CoV-2 pandemic, with appropriate screening and case selection, allows provision of necessary fetal intervention with maximal 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, coronavirus-2019; FETO, fetoscopic endoluminal tracheal occlusion; 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; SMFM, Society for Maternal and Fetal Medicine; TAPS, twin anemia polycythemia sequence; TTTS, twin-to-twin transfusion syndrome; WHO, World Health Organization; qRT-PCR, quantitative real time polymerase chain reaction.