Anesthetic Considerations for Maternal-Fetal Interventions

Advances in diagnosing and managing fetal anomalies have enabled the rapid evolution of maternal-fetal surgery (MFS). These surgeries are broadly categorized as minimally invasive, open, or ex utero intrapartum treatment (EXIT) procedures. A multidisciplinary team is required for these techniques with the anesthesia provider playing a pivotal role. A unique aspect of MFS is the need to manage both mother and fetus. Successful delivery of anesthesia requires knowledge of the physiologic changes of pregnancy, fetal physiology, maintenance of uteroplacental blood flow, and mitigating risk of general anesthesia. Additionally, understanding the underlying condition of the fetus and its surgical correction can ensure optimal anesthetic care. Certified registered nurse anesthetists (CRNAs) may have limited experience with MFS, but knowledge of these considerations will enable safer delivery of anesthesia. The type of anesthesia for MFS is determined by the surgical procedure. Open surgeries and EXIT procedures commonly require general anesthesia with fetal immobility, management of uterine atony, and preparation for fetal resuscitation. Minimally invasive procedures are often performed with local anesthesia and maternal sedation. MFS is a growing subspecialty with specific anesthetic considerations that CRNAs should be familiar with. This journal course aims to increase knowledge to promote safe anesthetic care for MFS.