The Blind Spot in Obstetric Anesthesia: Intra-Surgical Fetal Monitoring
Abstract
Introduction: There is a big gap in fetal monitoring in obstetric patients undergoing cesarean section during the transoperative period. Despite the astonishing technological developments in all medical areas, we have failed to develop a practical method for the evaluation of the fetus wellbeing during a c-section intervention.
Objective. A non-invasive and practical method is suggested that can be used in a site distant from the abdominal surgical field to record the continuous fetal heart rate as an indicator of fetal wellbeing. This task would not only involve the anesthesiologist, but the obstetrician and the pediatrician as well.
Methodology. Producing an article that should be food for thought, based on a question asked by students of anesthesiology in the OR (graduate and postgraduate students), about a practical method for intraoperative fetal, noninvasive monitoring. The search was conducted using the Medline, Ovid and Science Direct data basis.
Results. Notwithstanding the absence of an appropriate fetal monitoring method (optimal and practical) for this period of time in the OR, it is mandatory to find a technology-based solution to assess the wellbeing of the fetus during the transoperative period of the c-section, firstly because there are multiple factors that may extend the surgical time and become a determining factor for the lack of control of a hypoxic or schemic event of the fetus; secondly, because safety of obstetric and fetal anesthesia must be demanding and is critical.
References
2. American College of Obstetricians and Gynecologists. Intrapartum fetal heart rate monitoring. ACOG Practice Bulletin No. 70. Obstet Gynecol. 2005;106: 1453-60.
3. Gourounti K, Sandall J. Admission cardiotocography versus intermittent auscultation of fetal heart rate: effects on neonatal Apgar score, on the rate of caesarean sections and the rate of instrumental delivery. A systematic review. Int J Nurs Stud. 2007;44:1029-35.
4. Braveman F. Obstetrical Anesthesia. En: Barash PG, Cullen BF, Stoelting RK, editores. Clinical Anesthesia. 6th ed. Philadelphia: Lippincot Williams and Wilkins; 2009. p. 1138-70.
5. Birnbach D, Browne I. Anesthesia for obstetrics. En: Miller RD, Eriksson LI, Fleisher LA, et al, editors. Miller’s Anesthesia. 7th ed. Philadelphia: Elsevier; 2009. Chapter 69.
6. Ngan Kee WD, Khaw KS, Ma KC, et al. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial. Anesthesiology. 2006;104:14-20.
7. Penning DH. Fetal and neonatal neurologic injury. En: Chesnut DH, Polley LS, Tsen LC, et al, editors. Obstetric anesthesia: principles and practice. 4th ed. Philadelphia: Mosby Elsevier; 2009. Chapter 10.
8. Rosen MA. Anesthesia for fetal surgery and other intrauterine procedures. En: Chesnut DH, Polley LS, Tsen LC, et al, editors. Obstetric Anesthesia: principles and practice. 4th ed. Philadelphia: Mosby Elsevier; 2009. Chapter 7.
9. National Institute of child health and human development research planning workshop. Electronic fetal heart rate monitoring: research guidelines for interpretation. Am J Obstet Gynecol. 1997;177:1385-90.
10. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2002. Natl Vital Stat Rep. 2003;52: 1-113.
11. Low JA, Simpson LL, Tonni G, et al. Limitations in the clinical prediction of intrapartum fetal asphyxia. Am J Obstet Gynecol. 1995;172:801-4.
12. Figueras F, Albela S, Bonino S, et al. Visual analysis of antepartum fetal heart rate tracings: inter and intra observer agreement and impact of knowledge of neonatal outcome. J Perinat Med. 2005;33:241-5.
13. American College of Obstetricians and Gynecologists. Inappropiate use of the terms fetal distress and birth asphyxia. Int J Gynaecol Obstet. 1998;61:309-10.
14. Livingston EG. Intrapartum fetal assessment and terapy. En: Chesnut DH, Polley LS, Tsen LC, et al, editors. Obstetric anesthesia: principles and practice. 4th ed. Philadelphia: Mosby Elsevier; 2009. Chapter 8.
15. Tracker SB, Stroup DF, Peterson HB. Efficacy and safety of intrapartum electronic fetal monitoring: an update. Obstet Gynecol. 1995;86:613-620.
16. Vintzileos AM, Nochimson DJ, Guzmán ER, et al. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: a meta- analysis. Obstet Gynecol. 1995;85:149-55.
17. Low JA, Pickersgill H, Killen H, et al. The prediction and prevention of intrapartum fetal asphyxia in term pregnancies. Am J Obstet Gynecol. 2001;184: 724-30.
18. Parer JT. Handbook of fetal heart rate monitoring. 2nd ed. Philadelphia: WB Saunders; 1997.
19. Ordóñez CA, Martínez JE, Buitrago R. Valoración integral del estado hemodinámico en el paciente crítico. En: Ordóñez CA, Ferrada R, Buitrago R,. editores. Cuidado Intensivo y trauma. 2ª ed. Bogotá: Distribuna Editorial; 2009. p. 289-305.
20. Clarck LC Jr. Measurement of oxygen tension: a historical perspective. Crit Care Med. 1981;9:690-2.
21. Cunningham FG, Leveno KJ, Blomm SL, Hauth J, Rouse D, Spong C (Ed). Williams Obstetrics. 23ra ed. Bethesda, Maryland: McGraw-Hill Companies; 2010. Chapter 28.
22. Weiner CP, Wenstrom KD, Sipes SL, et al. Risk factors for cordocentesis and fetal intravascular transfusion. Am J Obstet Gynecol. 1991;165:1020-5.
23. Quintero RA, Shukla AR, Homsy YL, et al. Successful in utero endoscopi ablation of posterior urethal valves: a new dimensión in fetal urology. Urology. 2000;55:774.
24. Agarwal SK, Fisk NM. In utero therapy for lower urinary tract obstruction. Prenat Diagn. 2001;21: 970-6.
25. Lissauer D, Morris RK, Kilby MD. Fetal lower urinary tract obstruction. Semin Fetal Neonatal Med. 2007;12:464-70.
Downloads
Altmetric
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
