Fetal Monitoring During Maternal Cardiac Surgery With Cardiopulmonary Bypass

Koh, K. S.; Friesen, R. M.; Livingstone, Richard; Peddle, L. J.

doi:10.1097/00006254-197511000-00010

Cited by 17 publications

(22 citation statements)

References 1 publication

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“…Aventa-se a possibilidade de embolia por microbolhas, partículas ou empilhamento de hemácias, como causa de comprometimento da microcirculação útero-placentária. Ao nosso ver, existem três fatores de grande influência na queda dos batimentos fetais nesse momento: a hemodiluição, a hipotermia e o fluxo laminar 15 . Em conclusão, acreditamos que a utilização de monitorização da FC fetal e da contração uterina em gestantes, submetidas à cirurgia cardíaca, é de grande valia, pois observaram-se reações do feto em decorrência da CEC ajustando fluxo e temperatura conforme a necessidade, prevenindo assim maiores complicações, tanto para o feto quanto para a mãe.…”

Section: Discussionunclassified

Cirurgia valvar em gestantes. Experiência em oito casos

Pomerantzeff¹,

Benício²,

Brandão³

et al. 1998

Arq. Bras. Cardiol.

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Purpose -Os primeiros relatos de cirurgias cardíacas, realizadas durante a gravidez, surgiram no início da década de 50 1 , ainda no período de cirurgia cardíaca a céu fechado, sem circulação extracorpórea (CEC), observando-se que a mortalidade materna não estava aumentada em relação ao mesmo tipo de cirurgia realizada em não gestantes 2,3 . Entretanto, a mortalidade fetal elevou-se após a introdução da CEC, devida a ocorrência do trabalho de parto prematuro e ao óbito fetal intra-operatório (hipóxia) 4 . Devido ao melhor conhecimento das repercussões fetais, ocasionadas pela CEC, o aprimoramento desta técnica tem determinado a diminuição da mortalidade fetal. O objetivo deste estudo é analisar a evolução materna e fetal de oito gestantes submetidas à cirurgia cardíaca. MétodosForam analisadas retrospectivamente, oito gestantes submetidas à cirurgia cardíaca sob CEC entre janeiro/86 e dezembro/98. A idade das gestantes variou de 19 a 44 (média de 31,4±7,4) anos. A idade gestacional variou de 12 a 31 (mé-dia de 26,6±7,1) semanas.

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Section: Discussionunclassified

Cirurgia valvar em gestantes. Experiência em oito casos

Pomerantzeff¹,

Benício²,

Brandão³

et al. 1998

Arq. Bras. Cardiol.

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“…Fetal heart monitoring usually shows that the response to the initiation of CPB is bradycardia, which in most cases reverts to sinus rhythm immediately after cessation of CPB. 37 Alternatively, an initial tachycardia can occur, accompanied by an increase in blood pressure. 38 Fetal bradycardia observed after the initiation of CPB is corrected by increasing the blood flow, [37][38][39] and upon restoration of maternal circulation on discontinuation of CPB.…”

Section: Fetal Response To Cardiopulmonary Bypassmentioning

confidence: 99%

“…37 Alternatively, an initial tachycardia can occur, accompanied by an increase in blood pressure. 38 Fetal bradycardia observed after the initiation of CPB is corrected by increasing the blood flow, [37][38][39] and upon restoration of maternal circulation on discontinuation of CPB. 18 The mechanism of this bradycardic response is unknown, but various causes have been postulated, including fetoplacental dysfunction, fetal hypoxia and acidosis, maternal hypothermia, and drugs that cross the placental barrier, such as β-adrenergic blockers.…”

Section: Fetal Response To Cardiopulmonary Bypassmentioning

confidence: 99%

“…44 External monitoring of the fetal heart rate and the uterus is only an indirect measure of fetoplacental physiology, but it assists in the early recognition of the potentially deleterious effects of CPB, thus enabling timely intervention to minimize fetal mortality. 19,20,37 Continual and frequent monitoring of the fetus postoperatively is also recommended, because there is a risk of preterm labor in this period. 48 …”

Section: Fetal Response To Cardiopulmonary Bypassmentioning

confidence: 99%

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Cardiac surgery during pregnancy

Conolly¹,

Khan²

2012

Core Topics in Cardiac Anesthesia

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A pproximately 2% to 4% of women of childbearing age have concomitant heart disease.1 In the Western world, congenital heart disease (CHD) accounts for most of the structural heart disease that affects women of childbearing age.2 Acquired cardiac disease seen during pregnancy is mainly valvular in nature, usually a consequence of rheumatic fever.2 Even though rheumatic fever is decreasing in developed countries, it continues to be a serious problem in the developing world. Immigrants also form a high-risk population, especially those who are unaware of the inherent risks of heart disease during pregnancy or are even unaware of the presence of any cardiac disease. Mitral stenosis is the most common lesion encountered, 2 although its incidence is on the decline. Aortic valve disease is less common: aortic incompetence is usually a consequence of endocarditis (1 in 8,000 pregnancies) or aortic dissection, in which case there may be an underlying connective tissue disorder such as Marfan syndrome. Significant aortic stenosis is uncommon in this age group.3 Ischemic events during pregnancy are rare. The incidence of myocardial infarction is approximately 1 in 10,000 pregnancies. 4,5 Infarction is usually secondary to underlying coronary artery disease, although spontaneous coronary artery dissection seems to be more common during pregnancy and accounts for 30% of all myocardial infarctions seen in pregnancy. 6,7 Predictors of Maternal and Fetal OutcomeIn the United Kingdom, cardiac disease in the mother is the major cause of maternal death during pregnancy. Of these patients, 25% have CHD. 8 In a large, prospective multicenter study of pregnancy outcomes among women with heart disease, adverse maternal cardiovascular events were seen in 13% of patients. Independent predictors of maternal cardiac complications included prior cardiac events, New York Heart Association functional class III/IV or cyanosis, left-heart obstruction, and left ventricular systolic dysfunction (Table I). Neonatal complications were seen in 20% and were associated with poor functional class or cyanosis, left-heart obstruction, or smoking. 9A recent prospective observational study in pregnant patients with CHD found that both cardiac complication and neonatal complication rates were considerable in these women. In mothers, right subpulmonary ventricular systolic dysfunction and severe pulmonary regurgitation were predictors of an adverse fetal outcome. 10 In a recently published literature review that described the outcomes of 2,491 pregnancies among women with structural CHD, substantial cardiac complications were seen in 11% of the pregnancies. Obstetric complications did not appear to be more prevalent,

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“…17,18 In one instance a fetal heart rate of 60 was restored to 100 by an increase in pump flow from 3100 to 3600 ml/minute. 18 In addition to identifying potentially threatening events, all have reported a sustained fetal bradycardia to between 80 and 100 beats per minute during hypothermic cardiopulmonary bypass, which resolves with the restoration of maternal temperature and normal circulation. A recent metaanalysis revealed that fetal mortality was reduced to 0% when normotheric cardiopulmonary bypass was utilized.…”

Section: Cardiac Surgery During Pregnancymentioning

confidence: 99%

Anesthesia for the parturient with cardiovascular disease

Kuczkowski

2003

Southern African Journal of Anaesthesia and Analgesia

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Fetal Monitoring During Maternal Cardiac Surgery With Cardiopulmonary Bypass

Cited by 17 publications

References 1 publication

Cirurgia valvar em gestantes. Experiência em oito casos

Cirurgia valvar em gestantes. Experiência em oito casos

Cardiac surgery during pregnancy

Anesthesia for the parturient with cardiovascular disease

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