Maternal Hypotension during Fetoscopic Surgery: Incidence and Its Impact on Fetal Survival Outcomes

Abstract

In this retrospective cohort study, we aimed to determine the incidence of intraoperative maternal hypotension during fetoscopic surgery for twin-twin transfusion syndrome (TTTS) and to evaluate the impact of intraoperative hypotension on fetal survival. A total of 328 TTTS patients with recipient twin cardiomyopathy who underwent fetoscopic surgery under epidural anesthesia were included. The exposure of interest was maternal medical therapy with nifedipine for the treatment of fetal cardiomyopathy. We found that intraoperative hypotension occurred in 53.4% (175/328 patients). There was no statistically significant difference in incidence of hypotension between nifedipine exposure and nonexposure groups (54.8% versus 50.8%, P = 0.479). However, the nifedipine exposure group received a statistically significant higher dose of phenylephrine (7.04 ± 6.38 mcg/kg versus 4.70 ± 4.14 mcg/kg, P = 0.018) and higher doses of other vasopressor, as counted by number of treatments (6.06 ± 4.58 versus 4.96 ± 3.42, P = 0.022). There were no statistically significant differences in acute fetal survival rate (within 5 days) and fetal survival rate at birth between hypotensive and nonhypotensive patients. We concluded that preoperative exposure to nifedipine resulted in increased intraoperative maternal vasopressor requirement during fetoscopic surgery under epidural anesthesia. In patients who had intraoperative maternal hypotension, there was no correlation between the presence of maternal hypotension and postoperative fetal survival.

Outcome reporting across randomized trials and observational studies evaluating treatments for twin–twin transfusion syndrome: systematic review

“…Two hundred and thirty studies were therefore deemed eligible after full‐text review. From these, all randomized trials ( n = 6) and the largest observational studies ( n = 94) were selected for analysis (Figure ). There were 13 case–control studies, 32 prospective cohort studies and 49 retrospective cohort studies.…”

Seguridad de la anestesia neuroaxial en mujeres con embarazo gemelar y síndrome de transfusión feto-fetal, sometidas a fotocoagulación láser. Estudio de cohorte retrospectiva

“…No obstante, llama la atención la presencia de 21 casos de hipotensión sostenida (65,6 %), trece de ellos con la técnica epidural (72,2 %). Aspecto que recuerda lo reportado en la literatura, en donde se describe la presencia de hipotensión sostenida entre el 7,4 y el 75 % para pacientes llevadas a cesárea con anestesia neuroaxial (33)(34)(35). Esta frecuencia esperada del evento tiene su origen en los cambios hemodinámicos maternos que genera este tipo de técnica anestésica (v. g. reducción del gasto cardiaco al modificar la resistencia vascular periférica) (33)(34)(35).…”

Anaesthesia for foetoscopic Laser ablation- a retrospective study

“…However, subsequently, there was no further incidence of hypotension during rest of the foetoscopic procedure. In previous study[12] in patients undergoing selective FLA, the incidence of maternal hypotension under epidural anaesthesia was 53.4% in the second trimester. However, there was no statistically significant correlation between intraoperative maternal hypotension and foetal outcome in their study.…”

“…However, there was no statistically significant correlation between intraoperative maternal hypotension and foetal outcome in their study. [12]…”