title: Cardiac surgery during pregnancy: continuous fetal monitoring using umbilical artery Doppler flow velocity indices.
abstract: 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.
authors.affiliation: Department of Cardiaothoracic and Vascular Anesthesiology, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Mishra
authors.forename: Ravindra
authors.initials: R
authors.lastname: Sawhney
authors.forename: Anil
authors.initials: A
authors.lastname: Kumar
authors.forename: Kumar Ramesh
authors.initials: KR
authors.lastname: Bapna
authors.forename: Vijay
authors.initials: V
authors.lastname: Kohli
authors.forename: Harpreet
authors.initials: H
authors.lastname: Wasir
authors.forename: Naresh
authors.initials: N
authors.lastname: Trehan
mesh_terms: D000328:Adult; D062186:Arterial Pressure / Q000502:physiology; D020517:Atrial Appendage / Q000000981:diagnostic imaging; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D006333:Heart Failure / Q000209:etiology; D006340:Heart Rate, Fetal; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008944:Mitral Valve Insufficiency / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000601:surgery; D011247:Pregnancy / Q000502:physiology*; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D014264:Tricuspid Valve Stenosis / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging* / Q000502:physiology*