Intraoperative fetal heart monitoring for non-obstetric surgery: A systematic review

Microvascular free flap in a pregnant patient after resection of a high-grade neuroendocrine carcinoma

“…The use of pregnancy-safe anesthetic agents and continuous monitoring of the mother and the fetus are required. Furthermore, blood loss and hypotension in the mother should be managed on a higher threshold, since any level of systemic hypoperfusion would compromise fetal wellbeing (10).…”

Fetal heart rate monitoring in nonobstetric surgery: a systematic review of the evidence

“…In contrast to the previous systematic review, we reported an intraoperative delivery rate of 4% (3 of 74) and abnormal FHR findings in the majority of cases. Although Po et al reported reduced variability as not being a criterion for nonreassuring FHR monitoring (as "induction and maintenance of general anaesthesia is commonly associated with these phenomena"), 9 it is important to note that 1 intraoperative preterm cesarean delivery occurred because the obstetric team were unsure about these findings, a result of which the authors themselves were critical. 17 In addition, fetal bradycardia occurred frequently after maternal aortic cross-clamping with CBP surgery and did not always resolve with changes in maternal care.…”

“…Our findings are different from those of a recently published systematic review that studied case series with more than 5 participants. 9 A total of 41 cases were reviewed from 4 publications, representing over half of the cases included in this review. In contrast to the previous systematic review, we reported an intraoperative delivery rate of 4% (3 of 74) and abnormal FHR findings in the majority of cases.…”

“…A recent systematic review analyzed 4 publications of 41 cases of FHR monitoring for nonobstetric surgery in pregnancy, and reported that no intraoperative births were required and that nonreassuring FHR monitoring occurred in only 1 case (a fetal tachycardia associated with maternal pyrexia). 9 This review excluded both individual case reports and case series with fewer than 5 participants, potentially excluding important research findings in an area in which the evidence may largely be based on case reports. The objectives of this study were therefore as follows: first, to systematically review all of the evidence relating to FHR and uterine monitoring in nonobstetric surgery; and second, to examine the FHR pattern changes reported with general anesthesia for different types of surgery.…”

Desafios da anestesiologia em procedimentos cirúrgicos não-obstétricos durante o período gestacional

“…No que concerne ao acompanhamento cirúrgico, a monitorização fetal é indicada e deve ser realizada por profissional qualificado, pois permite diagnosticar e tratar os fatores desencadeantes de variabilidades na frequência cardíaca do feto. Po' et al (2019) realizaram o monitoramento intraoperatório da frequência cardíaca fetal em cirurgias não-obstétricas durante a gestação, das quais, 88% foram realizadas sob anestesia geral. Quanto à frequência, 66% foram por problemas neurológicos ou abdominais maternos, em média o período gestacional médio foi de 28 semanas.…”