Severe fetal bradycardia in a pregnant woman undergoing hypothermic cardiopulmonary bypass

Kawkabani, Nadine; N, Kawas; Baraka, Anis; Vogel, Tracey M.; Mangano, Christina Mora

doi:10.1016/s1053-0770(99)90275-6

Cited by 12 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All opiods may cause fetal bradycardia and loss of beat to beat variability. However this type of bradycardia is reversible [11,12]. In this case, the anesthetic agents did not seem to be responsible of the decrease in the FHR.…”

Section: Discussionmentioning

confidence: 89%

“…Goldstien et al found that hypothermia during CPBP had a deleterious effect on the fetus [2] while Roussow et al reported that the fetus maintains the capacity to autoregulate the fetal heart rate during moderate hypothermia due to a decrease in the metabolism requirements [13]. This hypothesis was supported by kawkabani et al who reported a case of fetal bradycardia during hypothermic (28 degrees) CPBP [11]. The heart rate returned to the normal values only after rewarming of the patient to 35 degrees Celsius.…”

Section: Discussionmentioning

confidence: 95%

“…Any factor that affect fetal oxygenation may have adverse effect on the fetal status. On the other hand many reports advice to adopt the alpha-stat management of carbon dioxide homeostasis which may maintain an adequate uteroplacental autoregulation and circulation during a moderate to tepid hypothermic cardiopulmonary bypass [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…They consider also that magnesium sulfate may not only prevent uterine contractions but prevent also hypothermic induced uterine vasoconstriction and increase the uteroplacental blood flow. To note that nitroglycerine was reported also to be an effective agent for uterine relaxation [11].…”

Section: Discussionmentioning

confidence: 99%

“…All the report discussing pregnant women undergoing cardiac procedures recommend close monitoring of the FHR, uterine contraction and utero-placental blood flow by echodoppler. Early recognition of fetal distress or uterine contractions will allow prompt management in order to avoid adverse outcome [11,12]. In this case, a continuous cardiac echodoppler of the fetus was performed throughout the surgery.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis

Kawkabani¹

2019

IJCTS

Self Cite

View full text Add to dashboard Cite

Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother's life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to decrease fetal morbidity and mortality such as tepid to normothermic cardiopulmonary bypass, good oxygenation, high hematocrit, pulsatile flow, alpha stat management, mean arterial pressure around 70mmhg and a pump flow above 2.4l/min. They recommend also a close monitoring of the fetal heart rate, uteroplacental blood flow and uterine contractions We report in this paper, the case of a 26 year old pregnant female who underwent at 18 weeks an aortic valve replacement. Severe fetal bradycardia occurred 30 min after going on bypass lasted for 20 min and was refractory to a further increase in pump flow, mean arterial pressure and hematocrit. The fetal heart rate returned to its baseline only after rewarming the patient to 35.5 degrees Celsius. The post-operative course was uneventful and a close follow up revealed a normal fetal status. At 38 weeks the mother delivered a healthy normal baby girl. Since fetal bradycardia occurred despite respecting all the recommendations and only reversed after rewarming the mother to 35.5 degrees Celsius, we would suggest not lowering the temperature during cardiopulmonary bypass below 35.5 degrees in pregnant patients undergoing cardiac procedures. Thus more reports and papers are mandatory in order to further elucidate the factors responsible of the adverse events that occur in such cases.

show abstract

Section: Discussionmentioning

confidence: 89%