Successful Anesthesia Management of Postoperative Maternal Pulmonary Edema and Uterine Hyperactivity following Open Fetal Myelomeningocele Repair

Abstract

Effective tocolysis is essential after fetal myelomeningocele repair and is associated with the development of pulmonary edema. The increased uterine activity in the immediate postoperative period is commonly treated with magnesium sulfate. However, other tocolytic agents such as nitroglycerine, nifedipine, indomethacin, terbutaline, and atosiban (outside the US) have also been used to combat uterine contractility. The ideal tocolytic regimen which balances the risks and benefits of in-utero surgery has yet to be determined. In this case report, we describe a unique case of fetal myelomeningocele repair complicated by maternal pulmonary edema and increased uterine activity resistant to magnesium sulfate therapy.

Anesthesia for fetal operative procedures: A systematic review

“…MFA was provided in 1,551 procedures from 59 studies ( 12 , 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , 83 , 85 , 86 , 88 , 95 , 98 , 100 , 104 , 106 , 108 , 112 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 172 , 176 , 177 ). Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 ,…”

“…Fetal anesthesia administration was specified in 50 studies, consisting of 635 intramuscular injections (45 studies), 292 subcutaneous injections (three studies) and four intravenous injections (two studies) ( 16 – 20 , 30 , 32 , 34 , 36 , 37 , 41 , 43 , 44 , 47 , 49 , 50 , 52 , 54 , 55 , 57 , 59 , 63 , 83 , 86 , 95 , 98 , 100 , 104 , 106 , 108 , 118 , 119 , 121 , 125 , 127 , 136 , 140 , 141 , 143 – 146 , 150 , 153 , 158 , 163 , 170 , 176 , 177 ). An aggregate mean GA at procedure of 27.99 weeks was calculated on 49 studies and 1,404 pregnancies ( 12 , 16 – 19 , 30 , 32 , 34 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 52 , 54 – 57 , 59 , 62 , 63 , 68 , …”

“…Mean LOH, based on data from 18 studies and 92 women, was 3.79 days ( 16 , 18 , 19 , 32 , 36 , 43 – 45 , 47 , 52 , 55 , 86 , 98 , 100 , 106 , 118 , 153 , 176 ). A total of 33 studies (1,196 pregnancies) provided information on the GA at delivery, resulting in an aggregate mean of 34.89 weeks ( 17 – 19 , 37 , 41 , 45 , 49 , 54 , 59 , 108 , 118 , 121 , 125 , 127 , 135 , 136 , 140 , 141 , 143 – 145 , 158 , 170 , 176 , 177 ). PROM occurred in 401 pregnancies (25.85%) and 197 fetal deaths were reported (11.37%).…”

“…MMC repair was described in 35 studies, totaling 1,372 patients. Open ( 16 , 20 , 24 , 28 , 40 , 46 , 54 , 73 , 85 , 86 , 91 , 113 , 115 , 120 , 121 , 127 , 137 , 154 , 156 , 158 , 166 , 172 , 176 , 177 ) and fetoscopic ( 17 – 19 , 28 , 29 , 33 , 99 , 134 , 140 , 171 , 178 ) repair were individually evaluated. One study was excluded due to cumulative data on both surgical approaches ( 41 ).…”

“…To evaluate the impact of fetal anesthesia, 81 studies, accounting for 2,112 patients, were considered. MA was performed in 827 procedures ( 11 , 24 , 28 , 29 , 33 , 39 , 40 , 46 , 50 , 51 , 58 , 65 , 73 , 75 – 78 , 81 , 90 , 91 , 99 , 101 , 113 , 115 , 120 , 130 , 134 , 137 – 139 , 152 , 154 , 157 , 159 , 166 , 171 , 173 , 175 , 178 ), while MFA in 1,285 ( 14 , 16 – 20 , 36 , 37 , 41 , 43 – 45 , 47 , 49 , 50 , 54 , 56 , 59 , 70 , 85 , 86 , 88 , 108 , 112 , 118 , 121 , 125 , 127 , 135 , 136 , 140 , 141 , 143 – 146 , 150 , 158 , 163 ...…”