The incidence of placenta previa/percreta are increasing in numbers and accounts for high maternal morbidity and mortality. This is a case of placenta previa/percreta successfully managed by multidisciplinary team. This case demonstrates that adequate knowledge, effective communication, and the availability and utilization of resources all play significant roles. The team includes an obstetrician, gynecologic oncologist, urologist, vascular surgeon, anesthesiologist, neonatologist, and blood bank and nursing personnel. Prenatal identification of risk factors and diagnosis aid in the implementation of treatment strategies by team. Team effort and elective delivery in a tertiary hospital is essential to improve both maternal and neonatal outcome.

Human ; Female ; Adult ; Placenta Previa ; Blood Banks ; Placenta Accreta ; Delivery, Obstetric ; Elective Surgical Procedures ; Patient Care Team

The survival rate and prognosis for neonates with airway obstruction is poor if not managed immediately after delivery. Ex utero intrapartum treatment (EXIT) is indicated for cases in which airway obstruction is anticipated. The procedure establishes the fetal airway prior to complete delivery while maintaining an intact uteroplacental circulation. Maintaining uteroplacental circulation, ensuring uterine relaxation, and temporizing placental detachment during the EXIT procedure are achieved by administering a higher dose of inhalation anesthetic and intravenous nitroglycerine. However, this can lead to maternal hypotension and compromised feto-placental perfusion, reduced fatal cardiac output and acidosis. It is therefore essential that these be managed using vasopressors and inotropes. This paper reports the first institutional experience with the EXIT procedure in the Philippines, presenting two cases of neonates with large cystic hygroma. One case was performed as an elective procedure, the other as emergency treatment.

Human ; Female ; Adult ; Acidosis ; Airway Obstruction ; Anesthetics, Inhalation ; Cardiac Output ; Emergency Treatment ; Fetus ; Hypotension ; Infant, Newborn ; Lymphangioma, Cystic ; Philippines ; Placental Circulation ; Pregnancy ; Prognosis ; Survival Rate

Fiberoptic-guided intubation (FOI) has been an indispensable component of difficult airway management especially in instances where anatomical limitations precluded use of conventional direct laryngoscopy. Its use, however, is not without risks.

This paper presents a 4-year-old female with a limited mouth opening scheduled for an elective oral commissurotomy who developed signs and symptoms of tension pneumothorax immediately following a successful fiberoptic nasotracheal intubation. Passive insufflation of high-flow oxygen through a flexible fiberoptic bronchoscope preloaded with a tight-fitting endotracheal tube led to accumulation of air. This caused lung hyperinflation and subsequently, pneumothorax.

Anesthesia ; Airway Management ; Intubation ; Pneumothorax ; complications