OBGYN (MFM) vs. PaedsSurg

[MSRSA]

I'd just like to know from anyone in OBGYN or Paeds Surg, which route would be the best to pursue in order to work on cases involving fetuses and neonates such as TTTS or TRAP sequence. Do you find that the integration between doctors from both services satisfactory when working on a single case?

I would really appreciate some feedback from anyone with some advice. Thank you in advance.

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[JackADeli]

I'd just like to know from anyone in OBGYN or Paeds Surg, which route would be the best to pursue in order to work on cases involving fetuses and neonates such as TTTS or TRAP sequence...

I'm not an OB/Gyn or pedsurgeon. I will admit I had to google search your abbreviations:

twin-to-twin transfusion syndrome (TTTS)
twin reversed-arterial-perfusion (TRAP) sequence

It would seem to me based on brief google search and GSurgery residency, these things are exceedingly ultraspecialized. Looking at the few things that came up....
TTTS treatment with amniodrainage.... I suspect ultraspecialized OB is the one performing that and not the pediatric surgeon

TTTS after 26 weeks gestation: is there a role for fetoscopic laser surgery?

...In severe second trimester TTTS, because of the poor survival rates with
conservative management, there is general consensus that therapy should be
offered. Fetoscopic laser coagulation of vascular anastomoses on the placental​

surface is associated with significantly higher perinatal survival and improved neurological outcome as compared with serial amioreduction

​

​

...​

TRAP treatment with hysterotomy and selective delivery... I suspect ultraspecialized OB is treating that too.

Twin-Reversed Arterial Perfusion (TRAP) Sequence: Case Reports and Review of Literature

...The most appropriate interventions for the varous clinical presentations of this disorder are as yet undetermined, and conservative nonintervention is often appropriate...

The route to pedesurge is vastly different then the route to OB/Gyn and/or MFM. The bread and butter of pedesurgery is also far afield from TTTS & TRAP. Are pede surgeons involved in these? Maybe, I suspect based on your question, probably somewhere...

It does seem based on the few things I found that these are predominantly OB type issues. I accept correction by anyone with further knowledge. I will also add that during my GSurgery training with long pediatric surgery rotations, none of the conditions you mention and/or their associated treatments ever made it to pediatric surgical case listings... i.e. never saw the pedsurgeons treating these in-utero conditions.

JAD

PS: this might be a thread better directed to the OB/Gyn area.

 

[MSRSA]

Thanx very much for the reply and the googling!

i'm still pre-med and was just curious. i assume, however, that paedsurg would be involved or be the primary surgeons for procedures directly on the fetus, such as EXIT (Ex-utero Intrapartum Treatment/Therapy) procedure for CHAOS (Congenital High Airway Obstruction Syndrome) correction etc. Or rather, let the OB do the hysterotomy and partial delivery, while the paedsurgeon intervenes on the fetus?

 

[oldbearprofessor]

In general, laser surgery for TTTS is done by perinatologists (OB/gyn). EXIT procedures are done by a combination in that the obstetricians are doing the c-section and pediatric surgeons any procedures on the fetus/baby.

Fetal surgery teams work as a large group team involving obstetrics, pediatric surgery and neonatology. 🙂

 

[skiz knot]

I'd just like to know from anyone in OBGYN or Paeds Surg, which route would be the best to pursue in order to work on cases involving fetuses and neonates such as TTTS or TRAP sequence. Do you find that the integration between doctors from both services satisfactory when working on a single case?

I would really appreciate some feedback from anyone with some advice. Thank you in advance.

I wouldn't focus too much on these exceedingly rare procedures. Once in medical school try to focus on learning all that you can, developing interests in all fields of medicine and then narrow your choice down, knowing that the "sexy" procedures are rare. You have to enjoy the "bread and butter" work of your specialty. There are probably very few physicians performing the procedures you have mentioned and they are certainly not commonplace.

 

[maxheadroom]

I wouldn't focus too much on these exceedingly rare procedures. Once in medical school try to focus on learning all that you can, developing interests in all fields of medicine and then narrow your choice down, knowing that the "sexy" procedures are rare. You have to enjoy the "bread and butter" work of your specialty. There are probably very few physicians performing the procedures you have mentioned and they are certainly not commonplace.

Agreed. These are exceedingly rare procedures. EXITs are typically done (at least from what I've seen) by a combo team of MFM & Pedi ENT +/- Pedi Surg. Fetal Surgery is still in its infancy. At the one center where I've seen it going on, it's a done with MFM supporting while a Pediatric Surgeon (with extensive extra training) does the surgery.

Good advice above. Find something where you love the day-to-day stuff and then develop your super-specialty niche practice after that.

 

[MSRSA]

Thank you very much to all the replies. I've got some added insight into the topic now. ;-)

 

[MSRSA]

Thank you very much to all the replies. I've got some added insight into the topic now. ;-)

 

[JackADeli]

I wouldn't focus too much on these exceedingly rare procedures. ...You have to enjoy the "bread and butter" work of your specialty. There are probably very few physicians performing the procedures you have mentioned and they are certainly not commonplace.

Agreed. It is great you are interested in new and novel things. The focus on in-utero interventions at the pre-medical school or earlier stage is way too premature.

While some centers may attempt these procedures, analysis later may find the few survival to be flukes and anecdote not repeatable. Some of the fascinating, "cutting edge", dramatic procedures seen on TV or 5 o'clock news today.... may, by the time you get into medical school, be found to NOT be a reasonable practice. Thus these procedures that seemed so enticing may be for lack of a better term "debunked" by the time you start considering residency. The other thing to also consider is that some "extreme measures" may no longer be funded... also eliminating them from the field of practice.

Best of luck, focus on your studies now (do not get distracted by the dramatic/news media/classmates/family) as that will greatly influence your ability to get into medical school.

JAD

 

[SocialistMD]

I'd just like to know from anyone in OBGYN or Paeds Surg, which route would be the best to pursue in order to work on cases involving fetuses and neonates such as TTTS or TRAP sequence. Do you find that the integration between doctors from both services satisfactory when working on a single case?

You have received some good answers. If your interest is in performing the procedures on the fetuses, you need to go the pediatric surgery route. If you want to operate on and manage the mother in these cases, look to Ob/Gyn.