title: Fetal Heart Rate Monitoring during Intrauterine Open Surgery for Myelomeningocele Repair.
abstract: OBJECTIVE
  The aim of this study was to assess fetal hemodynamics during intrauterine open surgery for myelomeningocele (MMC) repair by describing fetal heart rate (FHR) monitoring in detail related to each part of the procedure.
  
  
  METHODS
  A study was performed with 57 fetuses submitted to intrauterine MMC repair between the 24th and 27th week of gestation. Evaluations of FHR were made in specific periods: before anesthesia, after anesthesia, at the beginning of laparotomy, during uterus abdominal withdrawal, hysterotomy, neurosurgery (before incision, during early skin manipulation, spinal cord releasing, and at the end of neurosurgery), abdominal cavity reintroduction, and abdominal closure, and at the end of surgery. Means ± standard deviations of FHR were established for each period, and analysis of variance with repeated measures was used to assess differences between these periods. The mean differences were assessed with 95% confidence intervals and were analyzed by Tukey's multiple comparison test.
  
  
  RESULTS
  The mean FHR during the specific periods mentioned above was 140.2, 140, 139.2, 138.8, 135.1, 133.9, 123.1, 134.0, 134.5, 137.9, and 139.9 bpm, respectively (p < 0.0001). Comparing the different periods, the highest frequencies were observed in the initial and final moments. The neurosurgery stage presents lower frequencies, especially during the release of the spinal cord.
  
  
  CONCLUSIONS
  FHR monitoring revealed interesting findings in terms of physiological fetal changes during MMC repair, especially during neurosurgery, which was the most critical period.
authors: Fetal Surgery Unit, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine, Sx00E3;o Paulo Federal University (EPM-UNIFESP), Sx00E3;o Paulo, Brazil.
authors: Eduardo Félix Martins
authors: EF
authors: Santana
authors: Antônio Fernandes
authors: AF
authors: Moron
authors: Maurício Mendes
authors: MM
authors: Barbosa
authors: Herbene Jose Figuinha
authors: HJ
authors: Milani
authors: Stephanno Gomes Pereira
authors: SG
authors: Sarmento
authors: Edward
authors: E
authors: Araujo Júnior
authors: Liliam Cristine
authors: LC
authors: Rolo
authors: Sérgio
authors: S
authors: Cavalheiro
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005260:Female; D005323:Fetal Monitoring; D005333:Fetus / Q000503:physiopathology / Q000601:surgery*; D005865:Gestational Age; D006340:Heart Rate, Fetal; D006801:Humans; D008591:Meningomyelocele / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies