Management of cardiopulmonary bypass in pregnancy: challenges and progress in maternal-fetal protection

Maternal heart disease is a leading cause of maternal mortality, and the number of pregnant women requiring cardiac surgery has steadily increased despite advancements in diagnostic and therapeutic modalities. Cardiopulmonary bypass (CPB), while providing surgical support, introduces significant perioperative challenges due to the altered maternal physiology and the unique vulnerability of the fetus, with fetal mortality substantially exceeding maternal mortality. Therefore, maternal and fetal protection during CPB necessitates a comprehensive, multidisciplinary strategy encompassing preoperative planning, intraoperative modification, and postoperative management. Key elements include the optimization of surgical timing, precise CPB management with a focus on maintaining uteroplacental perfusion, minimization of inflammatory and ischemic injury to vital organs, safe anesthetic protocols, judicious pharmacological therapy, appropriate use of extracorporeal life support techniques, and continuous fetal heart rate monitoring. The implementation of these systematic maternal-fetal protective strategies is critical to improving both maternal and fetal outcomes in this high-risk population.