Fetal Cerrahi
Özet
Fetal cerrahi, anne karnındaki fetüsün anomalilerine yönelik multidisipliner bir yaklaşım gerektiren ileri düzey bir tıbbi müdahaledir. Bu operasyonlar; minimal invaziv, açık mid-gestasyonel ve EXIT (Ex Utero Intrapartum Treatment) prosedürleri olarak sınıflandırılır. Minimal invaziv teknikler genellikle lokal veya nöraksiyel anestezi altında fetoskopik yöntemlerle uygulanırken, açık cerrahi ve EXIT prosedürleri genel anestezi ve maternal-fetal perfüzyonun korunmasını gerektirir. Anestezi yönetimi; maternal güvenliği sağlamak, uterus gevşemesini (tokoliz) kontrol etmek, fetal analjeziyi yönetmek ve uteroplasental dolaşımı optimize etmek üzerine odaklanır. Preoperatif dönemde aspirasyon ve tromboemboli profilaksisi ile tokolitik hazırlık (indomethazin, atosiban veya magnezyum) kritik öneme sahiptir. İntraoperatif süreçte fetal immobilizasyon ve monitörizasyon hayatiyken, postoperatif dönemde erken doğum riskini önlemek için etkin ağrı kontrolü ve tokoliz devam ettirilmelidir. Sonuç olarak fetal cerrahi, maternal morbidite ile fetal fayda arasındaki dengenin titizlikle kurulması gereken, uzmanlaşmış bir ekip çalışmasıdır.
Fetal surgery is an advanced medical intervention requiring a multidisciplinary approach to treat fetal abnormalities in utero. These procedures are classified as minimally invasive, open mid-gestational, and EXIT (Ex Utero Intrapartum Treatment). While minimally invasive techniques are performed under local or neuraxial anesthesia using fetoscopy, open surgery and EXIT procedures require general anesthesia and the maintenance of maternal-fetal perfusion. Anesthetic management focuses on ensuring maternal safety, controlling uterine relaxation (tocolysis), managing fetal analgesia, and optimizing uteroplacental circulation. Preoperative preparation is critical, including aspiration and thromboembolism prophylaxis, along with tocolytic administration (indomethacin, atosiban, or magnesium). During the intraoperative phase, fetal immobilization and monitoring are vital, while postoperative care must continue effective pain control and tocolysis to prevent preterm labor. In conclusion, fetal surgery is a specialized team effort where the balance between maternal morbidity and fetal benefit must be meticulously established.
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