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DOPPLER ULTRASOUND FOR PERIOPERATIVE FETAL HEART RATE MONITORING
Abstract Number: SU-65
Abstract Type: Case Report/Case Series
Brain tumours during pregnancy is a complicated scenario which can jeopardise the lives of both the mother and foetus. Anaesthetic management of pregnant patient with intracranial space occupying lesion (SOL) requires modification of anaesthetic techniques(1) . Physiological changes during pregnancy necessitates heightened monitoring standards to ensure maternal and fetal safety (2).
A 19 year old pregnant woman, (35kg, ASA I) presented with an intra cranial mass lesion suggestive of a central neurocytoma. Fetal heart rate (FHR) monitoring (Doppler ultrasonography ) was initiated before induction, continued intraoperatively throughout till 48hrs postoperatively. Anesthetic management included thiopentone,fentanyl, rocuronium, sevoflurane and oxygen .Intraoperative monitoring included invasive blood pressure and central venous pressure . Intraoperative and recovery periods were uneventful and after regular followup patient had a normal antenatal course.
American College of Obstetricians and Gynaecologists (ACOG), recommends fetal monitoring and includes :
For previable fetus, ascertaining the fetal heart rate by Doppler before and after the procedure is sufficient. Selectively can be used for facilitating positioning .
For viable fetus is , simultaneous electronic fetal heart rate and contraction monitoring should be performed before, intraoperatively and after the procedure to assess fetal well-being and the absence of contractions.
• During surgery attention should be paid to fetal perfusion ,detection of foetal hypoxia and metabolic acidosis.
• Before 26 weeks of gestation , continuous FHR monitoring using Doppler USG may help in early detection of fetal hypoxia in the peri operative period.
• Each case warrants an individualized team approach (anesthesia and obstetric care providers, surgeons, pediatricians, and nurses).
• In this case, FHR monitoring with Doppler ultrasonography was found to be as useful as the standard electronic fetal monitoring (CTG). Craniotomy could be performed safely during the second trimester of pregnancy.
1. Wang LP, Paech MJ. Neuroanesthesia for the pregnant woman. Anesth Analg 2008;107:193 200.
2. Cok OY, Akin S, Aribogan A, Acil M, Erdogan B, Bagis T. Anesthetic management of 29 week pregnant patient undergoing craniotomy for pituitary macroadenoma – A case report. Middle East J Anaesthesiol 2010;20:593 6.