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Cardiac surgery during pregnancy: Continuous fetal monitoring using umbilical artery Doppler flow velocity indices


1 Department of Cardiaothoracic and Vascular Anesthesiology, Medanta The Medicity, Gurgaon, Haryana, India
2 Department of Cardiaothoracic and Vascular Surgery, Medanta The Medicity, Gurgaon, Haryana, India

Correspondence Address:
Manisha Mishra
D-2, Front Portion, SF, Kalindi Colony, New Delhi-110065
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124141

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Year : 2014  |  Volume : 17  |  Issue : 1  |  Page : 46-51

 

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The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5-29%. We report continuous monitoring of fetal heart rate and umbilical artery flow-velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.






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1 Department of Cardiaothoracic and Vascular Anesthesiology, Medanta The Medicity, Gurgaon, Haryana, India
2 Department of Cardiaothoracic and Vascular Surgery, Medanta The Medicity, Gurgaon, Haryana, India

Correspondence Address:
Manisha Mishra
D-2, Front Portion, SF, Kalindi Colony, New Delhi-110065
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.124141

Rights and Permissions

The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5-29%. We report continuous monitoring of fetal heart rate and umbilical artery flow-velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.






[FULL TEXT] [PDF]*


        
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