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Maternal Hemodynamic Management Using the FloTrac Monitor During Ex Utero Intrapartum Treatment for a Giant Fetal
Tomoe Fujita1,2, Shunsuke Hyuga1,2, Mariko Adachi1,2
1Division of Obstetric Anesthesia, Center for Perinatal Care, Child Health and Development, Kitasato University Hospital, Sagamihara City, Kanagawa, Japan.
None:
Ex utero intrapartum treatment requires profound uterine relaxation while preserving uteroplacental perfusion. Because uterine relaxants and high concentrations of volatile anesthetics may cause hypotension and increase blood loss, tight maternal hemodynamic control is essential. A healthy 36-year-old woman underwent ex utero intrapartum treatment at 32 weeks' gestation for a rapidly enlarging fetal cervical mass. We trended cardiac index and stroke volume variation using an arterial waveform analysis system and applied a predefined algorithm for fluid loading and phenylephrine titration. Maternal systolic blood pressure was maintained within 15% of the preinduction baseline during profound uterine relaxation with high-dose sevoflurane and intravenous nitroglycerin. The fetal airway was secured by tracheal intubation over 13 min with placental support. Maternal blood loss was 2850 mL, and the postoperative course was uneventful. Trend monitoring may help structure real-time fluid and vasopressor decisions during this procedure.
