Fetal Doppler monitoring during maternal open-heart surgery: Case report and key aspects of a multidisciplinary challenge.

Autor: Brandstetter M; Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria., Neuner M; Department of Anesthesiology, Paracelsus Medical University, Salzburg, Austria., Dinges C; Department of Heart Surgery, Paracelsus Medical University, Salzburg, Austria., Hofstätter E; Department of Neonatology, Paracelsus Medical University, Salzburg, Austria., Wohlmuth C; Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria., Fazelnia C; Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria., Fischer T; Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria., Bogner G; Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria. Electronic address: g.bogner@salk.at.
Jazyk: angličtina
Zdroj: European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2023 Aug; Vol. 287, pp. 63-66. Date of Electronic Publication: 2023 May 29.
DOI: 10.1016/j.ejogrb.2023.05.034
Abstrakt: Case Report: Herein we present the case of a 33-year nulliparous woman at 21 weeks of gestation with mitral valve vegetation resulting from infective endocarditis. Due to the mother's critical condition caused by consecutive thromboembolic events, surgery with cardiopulmonary bypass was indicated. During surgery the fetus was monitored by a specialized obstetrician who repetitively measured the Doppler indices of the umbilical artery, Ductus venosus and uterine artery. Right after CO 2 was insufflated into the operating area, the Doppler monitoring showed an increased Pulsatility Index of the Umbilical artery right before fetal distress with bradycardia occurred. A subsequent maternal arterial blood gas analysis showed an acidosis with hypercapnia. Consequently, the CO 2 insufflation was stopped and the gas flow on the Heart Lung Machine increased. After regaining homeostasis of acidosis, the Doppler Indices and fetal heart rate recovered. The remaining surgery and postoperative course were uneventful. At the 37 weeks of gestation a healthy boy was delivered by Cesarean section and at the age of two years, the neurodevelopment was assessed, which indicated normal development in mental cognition, language and motoric. This report presents a periodic Doppler examination of the maternal and fetal circulation during surgery on CPB while also discussing the possible impact of fetal monitoring in managing open cardiac surgery in pregnancy.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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