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Sinusoidal fetal heart rate pattern during cardiopulmonary bypass
1Department of Obstetrics and Gynecology, Washington Hospital Center, DC.
American Journal of Obstetrics and Gynecology
|July 1, 1990
Summary
A pregnant woman requiring emergency mitral valve replacement experienced a concerning sinusoidal fetal heart rate pattern during cardiopulmonary bypass. This fetal heart rate abnormality persisted despite optimized maternal hemodynamics and interventions.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Cardiovascular Surgery
Background:
- Cardiopulmonary bypass during pregnancy presents unique challenges for maternal and fetal well-being.
- Mitral valve disease requiring surgical intervention during gestation is rare.
Observation:
- A sinusoidal fetal heart rate pattern was observed in a fetus at 24 weeks' gestation during maternal cardiopulmonary bypass.
- The sinusoidal pattern was noted throughout the entire duration of the cardiopulmonary bypass procedure.
Findings:
- The sinusoidal fetal heart rate pattern persisted despite maintaining adequate pump flow (31 ml/m2 min).
- Intravenous phenylephrine administration to achieve a mean systemic arterial pressure of 50 mm Hg did not resolve the sinusoidal pattern.
Implications:
- Sinusoidal fetal heart rate patterns during cardiopulmonary bypass may indicate fetal distress or compromise.
- Further research is needed to understand the mechanisms and management of fetal heart rate abnormalities during complex cardiac procedures in pregnancy.
- Close fetal monitoring is crucial in pregnant patients undergoing cardiopulmonary bypass.