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Journal articles on the topic 'Fetal haemodynamic'

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Author: Grafiati

Published: 11 March 2023

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1

Vermeulen, Marijn J., Romy Gaillard, Kozeta Miliku, Irwin Reiss, Eric A. P. Steegers, Vincent Jaddoe, and Janine Felix. "Influence of genetic variants for birth weight on fetal growth and placental haemodynamics." Archives of Disease in Childhood - Fetal and Neonatal Edition 105, no. 4 (October 30, 2019): 393–98. http://dx.doi.org/10.1136/archdischild-2019-317044.

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ObjectiveTo determine the combined effect of 60 genetic variants (single nucleotide polymorphisms, SNPs), previously identified as being associated with birth weight, on fetal growth and placental haemodynamics throughout pregnancy.DesignProspective birth cohort (Generation R Study).SettingGeneral multiethnic population.Participants5374 singleton liveborn children with genome-wide association arrays and fetal growth data.MethodsLongitudinal and cross-sectional analyses of a genetic score of the total number of birth weight–increasing alleles across the 59 available SNPs and repeated fetal growth and haemodynamic measures.Main outcome measuresSD scores (SDS) of fetal weight, (femur) length, head circumference, umbilical artery pulsatility index, uterine artery mean resistance index and placental weight, in different periods of pregnancy until birth.ResultsIn longitudinal analyses, the effect of the genetic score on the fetal growth measures increased throughout pregnancy (p<0.001). At 20 weeks of gestation, the genetic score was not associated with any of the fetal growth measures, whereas at 30 weeks it was associated with all. The strongest effects were observed at birth: per SD increase in genetic score, birth weight increased by 0.15 SDS (95% confidence interval: 0.13 to 0.18), birth length by 0.12 SDS (0.08 to 0.19) and head circumference by 0.08 SDS (0.05 to 0.12). The genetic score was not associated with placental haemodynamics, but was associated with a 14 g (10 to 18) increase in placental weight per SDS increase in genetic score.ConclusionsOur results suggest that genetic variants related to birth weight exert their combined effect on fetal growth from second half of pregnancy onwards and have no effect on placental haemodynamics.

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2

Teixeira, Jeronima, Roberto Fogliani, Xenophon Giannakoulopoulos, Vivette Glover, and NicholasM Fisk. "Fetal haemodynamic stress response to invasive procedures." Lancet 347, no. 9001 (March 1996): 624. http://dx.doi.org/10.1016/s0140-6736(96)91327-6.

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3

Luzi, G., G. Coata, E. Chiaradia, G. Caserta, M. M. Anceschi, E. V. Cosmi, and G. C. Di Renzo. "MATERNAL HAEMODYNAMIC AND HAEMORRHELOGIC CONSIDERATIONS IN FETAL I.U.G.R." Journal of Perinatal Medicine 22, s1 (January 1994): 193–200. http://dx.doi.org/10.1515/jpme.1994.22.s1.193.

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4

Sivakumar, Kothandam, and Del-Rossi Sean. "Pulmonary artery to left atrial fistula: haemodynamic changes traced from fetus to infancy until its interventional closure." Cardiology in the Young 28, no. 10 (July 18, 2018): 1154–56. http://dx.doi.org/10.1017/s1047951118000616.

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AbstractCommunications between the pulmonary artery and left atrium cause cyanosis. The images document serial haemodynamic changes in such a fistula from fetal life to the postnatal period with a successful transcatheter intervention.

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5

Lakhno, Igor. "Fetal Non-invasive Electrocardiography Contributes to Better Diagnostics of Fetal Distress: A Cross-sectional Study Among Patients with Pre-eclampsia." Annals of the Academy of Medicine, Singapore 44, no. 11 (November 15, 2015): 519–23. http://dx.doi.org/10.47102/annals-acadmedsg.v44n11p519.

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Introduction: Fetal distress is a result of acute or chronic disturbances in the system of “mother-placenta-fetus” in pre-eclampsia (PE). The aim of the investigation was to compare the accuracy of antenatal fetal distress diagnostics in cases of traditional cardiotocography (CTG) waveform evaluation and analysis of morphological non-invasive electrocardiogram (ECG) parameters in anterpartum patients with PE. Materials and Methods: Fetal non-invasive ECG antenatal recordings of 122 pregnant patients at 34 to 40 weeks of gestation were examined. In Group I, there were 32 women with physiological gestation and normal fetal condition according to haemodynamic Doppler values. Group II involved 48 patients with mild and moderate PE whom were performed Doppler investigation. In Group III, 42 patients with severe PE were monitored with haemodynamic Doppler. Results: Fetal autonomic tone was lower with the relative increase of low frequency (LF) branch in the patients of pre-eclamptic group. The increased value of the amplitude of mode (AMo) and stress index (SI) was associated with adrenergic overactivity. It has induced pQ and QT shortening, increased T/QRS ratio and decelerations appearance. The rate of antenatal fetal distress retrospectively was 31.1 % in PE. The traditional analysis of CTG parameters has showed sensitivity (72.7%) and specificity (87.1%). In addition to the conventional CTG analysis, evaluation of ECG parameters has contributed to better diagnostics of fetal distress. Sensitivity and specificity of non-invasive fetal ECG were absolutely equal in this study (100%). Conclusion: The results suggest that fetal non-invasive ECG monitoring is more objective than conventional CTG. Key words: Fetal heart rate variability, Fetal monitoring, Hypertensive disorders of pregnancy

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Salame-Waxman, Daniel, Mara Escudero-Salamanca, and Nilda Espinola-Zavaleta. "Successful pregnancy in a patient with double outlet right ventricle." Cardiology in the Young 30, no. 4 (March 30, 2020): 594–96. http://dx.doi.org/10.1017/s1047951120000566.

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AbstractBackground:The double outlet right ventricle is uncommon and usually makes patients have haemodynamic and structural complications. Having a hyperdynamic state, such as pregnancy, with volume overload is very risky for a patient with complex CHD (CCHD). The diagnosis in early stages can prevent cardiac complications. The multi-disciplinary assessment of the disease lets patients make choices in treatment and reproductive life.Objective:Present a case of a successful pregnancy in a patient with a rare CCHD.Participant:A pregnant 19-year-old patient with a double outlet right ventricle without haemodynamic or structural complications and no fetal abnormalities.

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7

KISERUD, TORVID. "FETAL VENOUS CIRCULATION." Fetal and Maternal Medicine Review 14, no. 1 (February 2003): 57–95. http://dx.doi.org/10.1017/s0965539503001037.

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Ultrasound evaluation of the venous system is now a compulsory part of the haemodynamic assessment of the fetus. Once umbilical venous flow was introduced1,2 and its pulsatile pattern discovered in the compromised fetus,3 other sections of the venous system have been added or explored for possible diagnostic use: the inferior and superior vena cava,4,5 ductus venosus,6,7 hepatic veins,8 pulmonary veins,9,10 and intracranial veins.11-13 The following presentation is not intended to be a complete review of the fetal venous circulation, which is growing by the day, but rather to focus on some central issues with an emphasis on physiologic principles. The reason for this focus is that, as clinicians, we tend to work according to pattern recognition, which is a necessary principle in daily life. However, in the long run as the fetal patient increasingly demands a more dynamic approach to solve the diagnostic riddles, we find ourselves digging deeper into the physiological mechanisms behind ultrasound images and recordings.

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8

Mosimann, Beatrice, Sofia Amylidi-Mohr, Daniel V. Surbek, and Luigi Raio. "Double inferior vena cava in a monochorionic twin pregnancy with selective fetal growth restriction." BMJ Case Reports 14, no. 3 (March 2021): e240379. http://dx.doi.org/10.1136/bcr-2020-240379.

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Congenital anomalies of the infrarenal inferior vena cava (IVC) are well described in adult life, however, little information exists on their associations in fetal life. Here, we describe a case of a monochorionic diamniotic (MCDA) twin pregnancy complicated by selective fetal growth restriction (sFGR) with an incidental finding of a double IVC in one child. In fetal life, variants of the infrarenal IVC are strongly associated with heart defects, which might suggest haemodynamic alterations or genetic causes, even more so in our case with MCDA twins complicated by sFGR.

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9

Tiralongo, G. M., I. Pisani, B. Vasapollo, A. Khalil, D. Vinayagam, B. Thilaganathan, and H. Valensise. "F4. NO donors and haemodynamic changes in fetal growth restriction." Journal of Maternal-Fetal & Neonatal Medicine 29, sup2 (August 12, 2016): 29. http://dx.doi.org/10.1080/14767058.2016.1234789.

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10

Fulford, J., S. Dodampahala, S. Vadeyar, S. Francis, P. Baker, D. James, and P. Gowland. "Fetal cortical and haemodynamic response to a vibro-acoustic stimulus." NeuroImage 13, no. 6 (June 2001): 880. http://dx.doi.org/10.1016/s1053-8119(01)92222-0.

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11

Arduini, D., G. Rizzo, C. Romanini, and S. Mancuso. "Fetal haemodynamic response to acute maternal hyperoxygenation as predictor of fetal distress in intrauterine growth retardation." BMJ 298, no. 6687 (June 10, 1989): 1561–62. http://dx.doi.org/10.1136/bmj.298.6687.1561.

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12

Nakamura, S., D. W. Walker, and F. Y. Wong. "Cerebral haemodynamic response to somatosensory stimulation in near-term fetal sheep." Journal of Physiology 595, no. 4 (December 11, 2016): 1289–303. http://dx.doi.org/10.1113/jp273163.

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13

Cornette, J., JJ Duvekot, JW Roos-Hesselink, WCJ Hop, and EAP Steegers. "Maternal and fetal haemodynamic effects of nifedipine in normotensive pregnant women." BJOG: An International Journal of Obstetrics & Gynaecology 118, no. 4 (December 24, 2010): 510–15. http://dx.doi.org/10.1111/j.1471-0528.2010.02794.x.

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14

Ordonez, M. Victoria, Johanna Trinder, and Stephanie L. Curtis. "Success in a Fontan pregnancy: how important is ventricular function?" Cardiology in the Young 29, no. 2 (November 28, 2018): 225–27. http://dx.doi.org/10.1017/s1047951118001865.

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AbstractThe Fontan operation is a palliative surgical procedure for patients whose hearts cannot support a biventricular circulation. The haemodynamic changes that occur in pregnancy are particularly challenging for Fontan patients and the outcomes are variable. We present a case where fetal outcome was particularly poor despite a lack of high risk features pre-pregnancy.

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15

Kirkland, Jared D., Brian C. Dahlin, and William T. O'Brien. "Republished: The transclival artery: a variant persistent carotid–basilar arterial anastomosis not previously reported." Journal of NeuroInterventional Surgery 9, no. 3 (July 19, 2016): e11-e11. http://dx.doi.org/10.1136/neurintsurg-2016-012464.rep.

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During embryological development, primitive anastomoses exist between the carotid and vertebrobasilar arteries. These anastomoses typically regress or are incorporated into the developing vasculature. Persistence beyond fetal development, however, results in vascular anomalies that alter haemodynamic flow with a predisposition for aneurysm formation. The carotid–vertebrobasilar anastomoses mirror the primitive communications and include (from most to least common) the trigeminal, hypoglossal, proatlantal and otic arteries. The hypoglossal and proatlantal variants extend through the hypoglossal canal or foramen magnum, respectively. We present a previously undescribed variant of these persistent fetal anastomoses, the ‘transclival artery’, which courses through its own transclival skull base canal/foramen.

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16

Locci, Mariavittoria, Giovanni Nazzaro, Giuseppe De Placido, and Ugo Montemagno. "Fetal cerebral haemodynamic adaptation: a progressive mechanism? pulsed and color Doppler evaluation." Journal of Perinatal Medicine 20, no. 5 (January 1992): 337–43. http://dx.doi.org/10.1515/jpme.1992.20.5.337.

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17

ROBSON, S. C., G. SAMSOON, R. J. BOYS, C. RODECK, and B. MORGAN. "INCREMENTAL SPINAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION: MATERNAL AND FETAL HAEMODYNAMIC EFFECTS." British Journal of Anaesthesia 70, no. 6 (June 1993): 634–38. http://dx.doi.org/10.1093/bja/70.6.634.

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18

Knol, Ronny, Emma Brouwer, Alex S. N. Vernooij, Frans J. C. M. Klumper, Philip DeKoninck, Stuart B. Hooper, and Arjan B. te Pas. "Clinical aspects of incorporating cord clamping into stabilisation of preterm infants." Archives of Disease in Childhood - Fetal and Neonatal Edition 103, no. 5 (April 21, 2018): F493—F497. http://dx.doi.org/10.1136/archdischild-2018-314947.

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Fetal to neonatal transition is characterised by major pulmonary and haemodynamic changes occurring in a short period of time. In the international neonatal resuscitation guidelines, comprehensive recommendations are available on supporting pulmonary transition and delaying clamping of the cord in preterm infants. Recent experimental studies demonstrated that the pulmonary and haemodynamic transition are intimately linked, could influence each other and that the timing of umbilical cord clamping should be incorporated into the respiratory stabilisation. We reviewed the current knowledge on how to incorporate cord clamping into stabilisation of preterm infants and the physiological-based cord clamping (PBCC) approach, with the infant’s transitional status as key determinant of timing of cord clamping. This approach could result in optimal timing of cord clamping and has the potential to reduce major morbidities and mortality in preterm infants.

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19

Gardiner, Helena M. "Early Changes in Vascular Dynamics in Relation to Twin-Twin Transfusion Syndrome." Twin Research 4, no. 5 (October 1, 2001): 371–77. http://dx.doi.org/10.1375/twin.4.5.371.

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AbstractAclearer understanding of the early determinants of normal and abnormal vascular development is pivotal in order to identify those at increased risk of later vascular disease, and perhaps to prevent it by early intervention. Measurement of pulse wave velocity(PWV) has been used in the postnatal evaluation of the monochorionic(MC) twins. They are genetically identical and those with twin-twin transfusion syndrome(TTTS) provide an ideal natural model in whom to study the influence of differing haemodynamic stresses on the developing vascular tree. We investigated firstly whether surviving twin pairs with TTTS have altered arterial distensibility in childhood by comparing PWV in the radial arteries of surviving MC twin pairs with TTTS and in two control groups, one cohort of MC twins without TTTS and another dichorionic group (DC) Secondly, we tested a cohort of TTTS twin pair survivors treated with laser photocoagulation. The co-twin pairs in the group managed palliatively with amnioreduction showed increased PWV in the donor and reduced PWV in the recipient twins. This was neither seen in the laser-treated, nor in the control groups. Our studies suggest that a period of haemodynamic imbalance gives rise to changes in a muscular conduit artery that persist at least into infancy and it seems that by correcting the abnormal haemodynamics relatively soon after the disease process had begun, the alterations in elasticity are prevented. These studies are the first to demonstrate fetal programming of the vascular bed in humans, and prevention or reversal of this programming by an intervention in mid-gestation.

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Mori, Akira, Michiko Iwabuchi, and Tunehisa Makino. "Fetal haemodynamic changes in fetuses during fetal development evaluated by arterial pressure pulse and blood flow velocity waveforms." BJOG: An International Journal of Obstetrics and Gynaecology 107, no. 5 (May 2000): 669–77. http://dx.doi.org/10.1111/j.1471-0528.2000.tb13311.x.

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21

BISHRY, GASSER EL, and STEPHEN N. STURGISS. "ABSENT-END-DIASTOLIC FLOW VELOCITY IN THE UMBILICAL ARTERY." Fetal and Maternal Medicine Review 14, no. 3 (August 2003): 251–71. http://dx.doi.org/10.1017/s0965539503001116.

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Fetal growth restriction (FGR) as a consequence of uteroplacental insufficiency is an important contributor to perinatal death, neonatal morbidity and long-term health problems. Progressive uteroplacental dysfunction leads to placental respiratory failure and fetal hypoxaemia, which triggers compensatory fetal haemodynamic changes including blood flow redistribution towards essential fetal organs (brain, heart and adrenal glands) at the expense of the other body systems. The duration of the compensatory phase is variable, sometimes lasting weeks, and appears not to have deleterious short-term consequences. With further disease progression, the compensatory mechanisms reach their limit and myocardial dysfunction occurs. Once the disease enters this decompensatory phase, the fetus is at high risk of multisystem organ failure and in-utero demise. There is no effective in-utero therapeutic intervention. The main aim of management is to deliver the baby when the risks of antenatal demise and irreversible end-organ dysfunction associated with further prolongation of the pregnancy are greater than the risks from delivery.

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22

Vyas, Neetha, Neetha Poonja, Balika Shetty, and Supriya Rai. "Pulmonary thromboembolism and its complications in a patient in labour." BMJ Case Reports 15, no. 3 (March 2022): e248469. http://dx.doi.org/10.1136/bcr-2021-248469.

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Venous thromboembolic event in pregnancy is a rare but dreaded complication. When it occurs in labour, it presents with sudden severe fetal distress and maternal haemodynamic compromise. We present to you a case where in patient was taken up for emergency caesarean section for severe fetal distress. Intraoperative ECG showed right heart strain. Hence, an immediate bedside echocardiography was done in medical intensive care unit and it picked up a swirling thrombus in right atrium which immediately got dislodged to pulmonary vessels. Postcaesarean, we faced challenge of controlling active bleeding from atonic uterus with non-surgical techniques (Bakri balloon tamponade and uterine artery embolisation) before considering anticoagulation therapy for pulmonary embolism. The patient recovered well after anticoagulation treatment.

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Prokhorova, V. S., N. G. Pavlova,, V. V. Kozlov, and A. V. Novikova. "Fetal growth retardation in multiple pregnancy: anthropometrical and haemodynamic criteria of early antenatal diagnosis." Journal of obstetrics and women's diseases 50, no. 2 (December 30, 2021): 50–54. http://dx.doi.org/10.17816/jowd89487.

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Ultrasound investigation o f feta l biometry and haemodynamic indices in fetoplacental system during pregnancy since 14 weeks was carried out in 53 women havingtwins as a result o f spontaneous pregnancy or using o f assisted reproductive technology methods. The frequency and possible reasons oflU G R development in multiple pregnancy were analyzed. To predict the possibility o f IUG R in II and III trimester o f multiple pregnancy the mathematic model was worked out based on the standard fetometric indices measuring at 14-16 weeks o f pregnancy.

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Bejiqi, Ramush, Ragip Retkoceri, and Hana Bejiqi. "Prenatally Diagnosis and Outcome of Fetuses with Cardiac Rhabdomyoma - Single Centre Experience." Open Access Macedonian Journal of Medical Sciences 5, no. 2 (March 20, 2017): 193–96. http://dx.doi.org/10.3889/oamjms.2017.040.

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BACKGROUND: Cardiac rhabdomyoma (CRs) are the most common primary tumour of the heart in infants and children. Usually are multiple and, basing on the location can cause a haemodynamic disturbance, dysrhythmias or heart failure during the fetal and early postnatal period. CRs have a natural history of spontaneous regression and are closely associated with tuberous sclerosis complex (TSC). It has an association with tuberous sclerosis (TS), and in those, the tumour may regress and disappear completely, or remain consistent in size. AIM: We aimed to evaluate the prenatal diagnosis, clinical presentation and outcome of CRs and their association with TSC in a single centre. The median follow-up period was three years (range: 6 months - 5 years). MATERIAL AND METHODS: We reviewed medical records of all fetuses diagnosed prenatally with cardiac rhabdomyoma covering the period January 2010 to December 2016 which had undergone detailed ultrasound evaluation at a single centre with limited technical resources. RESULTS: Twelve fetuses were included in the study; mostly had multiple tumours and a total of 53 tumours were identified in all patients - the maximum was one fetus with16 tumours. All patients were diagnosed prenatally by fetal echocardiography. In two patient's haemodynamic disturbances during the fetal period was noted and pregnancies have been terminated. After long consultation termination of pregnancy was chosen by the parents in totally 8 cases. In four continuing pregnancies during the first year of live tumours regressed. TSC was diagnosed in all patients during the follow-up. CONCLUSIONS: Cardiac rhabdomyoma are benign from the cardiovascular standpoint in most affected fetuses. An early prenatal diagnosis may help for an adequate planning of perinatal monitoring and treatment with the involvement of a multidisciplinary team. Large tumour size, the number of tumours and localisation may cause hydrops, and they are significantly associated with poor neonatal outcome.

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Nwagwu, Margaret O., Anna Cook, and Simon C. Langley-Evans. "Evidence of progressive deterioration of renal function in rats exposed to a maternal low-protein dietin utero." British Journal of Nutrition 83, no. 1 (January 2000): 79–85. http://dx.doi.org/10.1017/s0007114500000118.

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Intrauterine growth retardation associated with maternal undernutrition is proposed to play a significant role in the aetiology of hypertension and CHD. Animal experiments suggest that the kidney, which is extremely vulnerable to the adverse effects of growth-retarding factors, may play an important role in the prenatal programming of hypertension. Maintenance of renal haemodynamic functions following structural impairment in fetal life is proposed to require adaptations which raise systemic blood pressure and promote a more rapid progression to renal failure. Rats were fed on diets containing 180 g casein/kg (control) or 90 g casein/kg (low protein) during pregnancy. The offspring were studied in terms of blood pressure, creatinine clearance, blood urea N, plasma and urinary albumin, renal morphometry and metabolic activity at 4, 12 and 20 weeks of age. Blood pressure was elevated at all ages in the low-protein-exposed offspring, relative to control rats. Rats (4 weeks old) exposed to the low-protein diet had smaller kidneys which were shorter and wider than those of control animals. Creatinine clearance was significantly reduced in 4-week-old rats exposed to the low-protein diet. Renal morphometry and creatinine clearance at older ages were not influenced by prenatal diet. Blood urea N, urinary output and urinary albumin excretion were, however, significantly greater in low-protein-exposed rats than in control rats at 20 weeks of age. These findings are suggestive of a progressive deterioration of renal function in hypertensive rats exposed to mild maternal protein restriction during fetal life. This is consistent with the hypothesis that adaptations to maintain renal haemodynamic functions following impairment of fetal nephrogenesis result in an accelerated progression towards glomerulosclerosis and increased intrarenal pressures mediated by rising vascular resistance.

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URSEM, Nicolette T. C., Piet C. STRUIJK, Wim C. J. HOP, Edward B. CLARK, Bradley B. KELLER, and Juriy W. WLADIMIROFF. "Heart rate and flow velocity variability as determined from umbilical Doppler velocimetry at 10–20 weeks of gestation." Clinical Science 95, no. 5 (November 1, 1998): 539–45. http://dx.doi.org/10.1042/cs0950539.

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1.The aim of this study was to define from umbilical artery flow velocity waveforms absolute peak systolic and time-averaged velocity, fetal heart rate, fetal heart rate variability and flow velocity variability, and the relation between fetal heart rate and velocity variables in early pregnancy. 2.A total of 108 women presenting with a normal pregnancy from 10 to 20 weeks of gestation consented to participate in a cross-sectional study design. Doppler ultrasound recordings were made from the free-floating loop of the umbilical cord. 3.Umbilical artery peak systolic and time-averaged velocity increased at 10–20 weeks, whereas fetal heart rate decreased at 10–15 weeks of gestation and plateaued thereafter. Umbilical artery peak systolic velocity variability and fetal heart rate variability increased at 10–20 and 15–20 weeks respectively. 4.The inverse relationship between umbilical artery flow velocity and fetal heart rate at 10–15 weeks of gestation suggests that the Frank–Starling mechanism regulates cardiovascular control as early as the late first and early second trimesters of pregnancy. A different underlying mechanism is suggested for the observed variability profiles in heart rate and umbilical artery peak systolic velocity. It is speculated that heart rate variability is mediated by maturation of the parasympathetic nervous system, whereas peak systolic velocity variability reflects the activation of a haemodynamic feedback mechanism.

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ROBSON, S. C., R. J. BOYS, C. RODECK, and B. MORGAN. "MATERNAL AND FETAL HAEMODYNAMIC EFFECTS OF SPINAL AND EXTRADURAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION." British Journal of Anaesthesia 68, no. 1 (January 1992): 54–59. http://dx.doi.org/10.1093/bja/68.1.54.

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28

PATEL, M., A. SWAMI, and H. DENT. "MATERNAL AND FETAL HAEMODYNAMIC EFFECTS OF SPINAL AND EXTRADURAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION." British Journal of Anaesthesia 68, no. 6 (June 1992): 635–36. http://dx.doi.org/10.1093/bja/68.6.635-c.

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ROBSON, S. C. "MATERNAL AND FETAL HAEMODYNAMIC EFFECTS OF SPINAL AND EXTRADURAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION." British Journal of Anaesthesia 68, no. 6 (June 1992): 636. http://dx.doi.org/10.1093/bja/68.6.636.

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30

Bijl, Rianne C., Jérôme M. J. Cornette, Annemien E. van den Bosch, Johannes J. Duvekot, Jeroen Molinger, Sten P. Willemsen, Anton H. J. Koning, et al. "Study protocol for a prospective cohort study to investigate Hemodynamic Adaptation to Pregnancy and Placenta-related Outcome: the HAPPO study." BMJ Open 9, no. 11 (November 2019): e033083. http://dx.doi.org/10.1136/bmjopen-2019-033083.

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IntroductionThe importance of cardiovascular health in relation to pregnancy outcome is increasingly acknowledged. Women who develop certain pregnancy complications, in particular preeclampsia, are at higher risk for future cardiovascular disease. Independent of its outcome, pregnancy requires a substantial adaptive response of the maternal cardiovascular system. In the Hemodynamic Adaptation to Pregnancy and Placenta-related Outcome (HAPPO) study, we aim to examine longitudinal maternal haemodynamic adaptation to pregnancy from the preconception period onwards. We hypothesise that women who will develop adverse pregnancy outcomes have impaired cardiovascular health before conception, leading to haemodynamic maladaptation to pregnancy and diminished uteroplacental vascular development.Methods and analysisIn this prospective cohort study embedded in the Rotterdam periconception cohort, 200 women with a history of placenta-related pregnancy complications (high-risk group) and 100 women with an uncomplicated obstetric history (low-risk group) will be included. At five moments (preconception, first, second and third trimester and postdelivery), women will undergo an extensive examination of the macrocirculatory and microcirculatory system and uteroplacental vascular development. The main outcome measures are differences in maternal haemodynamic adaptation to pregnancy between women with and without placenta-related pregnancy complications. In a multivariate linear mixed model, the relationship between maternal haemodynamic adaptive parameters, (utero)placental vascularisation indices and clinical outcomes (occurrence of pregnancy complications, embryonic and fetal growth trajectories, miscarriage rate, gestational age at delivery, birth weight) will be studied. Subgroup analysis will be performed to study baseline and trajectory differences between high-risk and low-risk women, independent of subsequent pregnancy outcome.Ethics and disseminationThis study protocol was approved by the Medical Ethics Committee of the Erasmus MC, Rotterdam, the Netherlands (MEC 2018–150). Results will be disseminated to the medical community by publications in peer-reviewed journals and presentations at scientific congresses. Also, patient associations will be informed and the public will be informed by dissemination through (social) media.Trial registration numberNL7394 (www.trialregister.nl)

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Burton, Graham J., and Abigail L. Fowden. "The placenta: a multifaceted, transient organ." Philosophical Transactions of the Royal Society B: Biological Sciences 370, no. 1663 (March 5, 2015): 20140066. http://dx.doi.org/10.1098/rstb.2014.0066.

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The placenta is arguably the most important organ of the body, but paradoxically the most poorly understood. During its transient existence, it performs actions that are later taken on by diverse separate organs, including the lungs, liver, gut, kidneys and endocrine glands. Its principal function is to supply the fetus, and in particular, the fetal brain, with oxygen and nutrients. The placenta is structurally adapted to achieve this, possessing a large surface area for exchange and a thin interhaemal membrane separating the maternal and fetal circulations. In addition, it adopts other strategies that are key to facilitating transfer, including remodelling of the maternal uterine arteries that supply the placenta to ensure optimal perfusion. Furthermore, placental hormones have profound effects on maternal metabolism, initially building up her energy reserves and then releasing these to support fetal growth in later pregnancy and lactation post-natally. Bipedalism has posed unique haemodynamic challenges to the placental circulation, as pressure applied to the vena cava by the pregnant uterus may compromise venous return to the heart. These challenges, along with the immune interactions involved in maternal arterial remodelling, may explain complications of pregnancy that are almost unique to the human, including pre-eclampsia. Such complications may represent a trade-off against the provision for a large fetal brain.

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Kwee, A., G. C. M. Graziosi, J. H. Schagen Leeuwen, F. V. Venrooy, D. Bennink, B. W. J. Mol, B. J. Cohlen, and G. H. A. Visser. "The effect of immersion on haemodynamic and fetal measures in uncomplicated pregnancies of nulliparous women." BJOG: An International Journal of Obstetrics and Gynaecology 107, no. 5 (May 2000): 663–68. http://dx.doi.org/10.1111/j.1471-0528.2000.tb13310.x.

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Forhead, AJ, AL Fowden, M. Silver, P. Hughes, F. Broughton-Pipkin, and MF Sutherland. "Haemodynamic responses to an angiotensin II receptor antagonist (GR 117289) in maternal and fetal sheep." Experimental Physiology 80, no. 2 (March 1, 1995): 285–98. http://dx.doi.org/10.1113/expphysiol.1995.sp003848.

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Kwee, A., G. C. M. Graziosi, J. H. Schagen van Leeuwen, F. V. van Venrooy, D. Bennink, B. W. J. Mol, B. J. Cohlen, and G. H. A. Visser. "The Effect of Immersion on Haemodynamic and Fetal Measures in Uncomplicated Pregnancies of Nulliparous Women." Obstetrical & Gynecological Survey 55, no. 11 (November 2000): 671–72. http://dx.doi.org/10.1097/00006254-200011000-00004.

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Więckowska, Katarzyna, Katarzyna Zych-Krekora, Maciej Słodki, and Maria Respondek-Liberska. "Original paper. Do Umbilical Cord Wrapped Around the Fetal Body Can Mimic Signs of Aortal Coarctation?" Prenatal Cardiology 6, no. 1 (January 1, 2016): 82–86. http://dx.doi.org/10.1515/pcard-2016-0011.

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Abstract Objectives: Coarctation of the aorta (CoA) is an irreversible congenital heart defect. Its prenatal diagnosis is not rare a subject to false-positive conclusion. We present a novel hypothesis explaining the basis of this error. Methods: Ten cases of prenatal suspicion of the coarctation of the aorta (based on disproportion at the level of 4 chamber view and mediastinum) coincidenced with the umbilical cord wrapped around the fetal body were found in the Filemaker datebase of the Fetal Cardiology Department. Only single pregnancies were taken into account. In all cases another cardiac and extracardiac malformations were excluded. Results: The mean maternal age was 29,6 years. The mean gestational age was 33 7/8 weeks. All fetuses were in a good cardiovascular condition. The usual position of the umbilical cord was neck, but they were also location such as nucha, abdomen or lower limb. At birth, all newborns had normal anatomy of the heart. We conclude that the explanation of the false diagnosis was haemodynamic, resulting from the compression of the fetal neck by the umbilical cord that resulted in a disproportion of cardiac blood flow, “mimicking” CoA. Conclusions: 1. Functional disturbances can mimic prenatal CoA. 2. Umbilical cord position (specially enlacing the fetus neck) should be taken into consideration in suspected cases of fetal CoA.

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Chaudhry, Shahid Adalat, Mubashar Iqbal, Muhammad Nadeem Khan, Aurooj Fatima, Hina Zubair, and Madiha Haroon. "A Comparative Study of Ephedrine and Phenylephrine in Averting Hypotension during Cesarean Section under Spinal Anesthesia." Pakistan Journal of Medical and Health Sciences 16, no. 1 (January 30, 2022): 967–70. http://dx.doi.org/10.53350/pjmhs22161967.

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Maternal haemodynamic variations are communal during caesarean section by spinal anesthesia. Several measures are adopted to treat hypotension. The aim of this study is to compare the effectiveness of phenylephrine and ephedrine in treating and preventing hypotension during C-section by spinal anesthesia and its outcome on the condition of the fetus. Place and Duration: In the Anesthesia department of Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six-months duration from July 2021 to December 2021. Methods: 120 total ASA grade-I patients with normal single pregnancy over 36 weeks who endured planned caesarean-section under spinal-anesthesia were randomized into 2 groups equally. Group I was given 5 mg rescue bolus and 10 mg prophylactic bolus dose of ephedrine intravenously during intrathecal block. Group II received 50 µg of rescue bolus and 100 µg of an intravenous dose of prophylactic phenylephrine bolus during intrathecal block. Haemodynamic variables such as heart rate and blood pressure were documented after every-2-mints until birth and every 5-minutes thereafter. The neonatal score was measured using the 1- and 5-minute Apgar scale and the pH value of the neonatal blood in the umbilical cord. Results: There were no differences in the treatment of hypotension among the 2 groups. The bradycardia incidence was greater in the group of phenylephrine. The variances in Apgar score, birth weight and umbilical cord pH amid the 2 groups were not statistically significant. Conclusions: Ephedrine and phenylephrine are similarly operative in the treatment of hypotension during elective caesarean section given spinal anesthesia. No statical variance in the occurrence of true fetal acidosis between the two vasopressors was noticed. Both groups have good neonatal outcome. Key words: Fetal acidosis, ephedrine, phenylephrine, hypotension and spinal anesthesia.

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Marcus, M. A. E., W. Gogarten, J. D. Vertommen, H. Buerkle, and H. Van Aken. "Haemodynamic effects of repeated epidural test-doses of adrenaline in the chronic maternal-fetal sheep preparation." European Journal of Anaesthesiology 15, no. 3 (May 1998): 320–23. http://dx.doi.org/10.1097/00003643-199805000-00013.

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Marcus, M. A. E., W. Gogarten, J. D. Vertommen, H. Buerkle, H. Van Aken, and Gertie F. Marx. "Haemodynamic Effects of Repeated Epidural Test-Doses of Adrenaline in the Chronic Maternal-Fetal Sheep Preparation." Obstetric Anesthesia Digest 19, no. 1 (March 1999): 31–50. http://dx.doi.org/10.1097/00132582-199903000-00016.

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Marcus, Gogarten, Vertommen, Buerkle, and H. "Haemodynamic effects of repeated epidural test-doses of adrenaline in the chronic maternal-fetal sheep preparation." European Journal of Anaesthesiology 15, no. 3 (May 1998): 320–23. http://dx.doi.org/10.1046/j.1365-2346.1998.00298.x.

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Roghair, Robert D., John A. Wemmie, Kenneth A. Volk, Thomas D. Scholz, Fred S. Lamb, and Jeffrey L. Segar. "Maternal antioxidant blocks programmed cardiovascular and behavioural stress responses in adult mice." Clinical Science 121, no. 10 (July 25, 2011): 427–36. http://dx.doi.org/10.1042/cs20110153.

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Intra-uterine growth restriction is an independent risk factor for adult psychiatric and cardiovascular diseases. In humans, intra-uterine growth restriction is associated with increased placental and fetal oxidative stress, as well as down-regulation of placental 11β-HSD (11β-hydroxysteroid dehydrogenase). Decreased placental 11β-HSD activity increases fetal exposure to maternal glucocorticoids, further increasing fetal oxidative stress. To explore the developmental origins of co-morbid hypertension and anxiety disorders, we increased fetal glucocorticoid exposure by administering the 11β-HSD inhibitor CBX (carbenoxolone; 12 mg·kg−1 of body weight·day−1) during the final week of murine gestation. We hypothesized that maternal antioxidant (tempol throughout pregnancy) would block glucocorticoid-programmed anxiety, vascular dysfunction and hypertension. Anxiety-related behaviour (conditioned fear) and the haemodynamic response to stress were measured in adult mice. Maternal CBX administration significantly increased conditioned fear responses of adult females. Among the offspring of CBX-injected dams, maternal tempol markedly attenuated the behavioural and cardiovascular responses to psychological stress. Compared with offspring of undisturbed dams, male offspring of dams that received daily third trimester saline injections had increased stress-evoked pressure responses that were blocked by maternal tempol. In contrast, tempol did not block CBX-induced aortic dysfunction in female mice (measured by myography and lucigenin-enhanced chemiluminescence). We conclude that maternal stress and exaggerated fetal glucocorticoid exposure enhance sex-specific stress responses, as well as alterations in aortic reactivity. Because concurrent tempol attenuated conditioned fear and stress reactivity even among the offspring of saline-injected dams, we speculate that antenatal stressors programme offspring stress reactivity in a cycle that may be broken by antenatal antioxidant therapy.

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Prokhorova, V. S., N. G. Pavlova, and N. N. Konstantinova. "Features of functional maturation of the central nervous system in fetuses with multiple pregnancies." Journal of obstetrics and women's diseases 50, no. 4 (December 30, 2021): 58–63. http://dx.doi.org/10.17816/jowd95645.

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The study was undertaken to detect some peculiarities of fetal rest activity cycle formation in multiple pregnancy. 86 fetuses (43 twins) were observed with the following assessment of the newbornsneurological status. The rest activity cycle parameters and haemodynamic indices of fetoplacental system were examined. Also there was considered the influence of IUGR and twins birth weight discordance on CNSfunctionalformation. The results showed that twins comparing with single pregnancies are characterized by the retardation of rest activity cycle formation that is manifested in shortening оf the quite and prolongation оf the intermediate states, lowering of cardiac rhythm variability and motorcardial reflex. These findings substantiate the necessity of including twins into high-risk group concerning neurological disorders in the newborns. The IUGR appears an additional factor increasing this risk.

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Sharma Koirala, Poonam. "Obstetric outcome in patients with rheumatic heart disease: experience of a tertiary hospital." Nepalese Heart Journal 14, no. 2 (November 1, 2017): 31–34. http://dx.doi.org/10.3126/njh.v14i2.18500.

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Background and Aims: Pregnancy in patients with rheumatic heart disease has always been challenging. Haemodynamic changes in pregnancy with diseased heart may cause adverse maternal and fetal outcome.Methods: A prospective study was done in pregnant women with rheumatic heart disease over a period of 2 years from 2015 to 2016 at Tribhuwan University Teaching Hospital, Kathmandu. Baseline data collected at antenatal period were analyzed with obstetric outcomes.Results: A total of 85 women were enrolled in this study. Sixty percent of the women were primigravida. Mitral stenosis was the commonest lesion (69.41%), followed by mitral regurgitation (25.88%) and aortic stenosis (4.71%). Cardiac events were noted in 32 patients out of which 11 developed pulmonary oedema and 6 had new onset of atrial fibrillation. Vaginal delivery (58.82%) was the commonest mode of delivery followed by cesarean section (24.7%). Eighty percent of women remained in NYHA functional class I and II, whereas 20% had deterioration of functional class. There were more maternal and fetal complications in women with NYHA III or IV in comparison to women with NYHA I or II. Low birth weight infants were found in 37.64% of cases. There was one maternal death in a lady with severe mitral stenosis with moderate mitral regurgitation due to congestive heart failure at 34 weeks of gestation. There were 8 fetal and 11 neonatal deathConclusions: Functional cardiac status during pregnancy has a major impact on maternal and fetal outcome. Rheumatic heart disease diagnosed before pregnancy may improve the outcome.Nepalese Heart Journal 2017; 14(2): 31-34

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Saha, Shubhashis, Anuja Abraham, Preethi Raja Navaneethan, and Kavitha Abraham. "Placenta percreta presenting as uterine rupture following previous B-Lynch suture." BMJ Case Reports 14, no. 10 (October 2021): e245593. http://dx.doi.org/10.1136/bcr-2021-245593.

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Placenta accreta spectrum disorder varies from minimally adherent placenta to deeply invasive placenta. Placenta percreta is a rare cause for uterine rupture and the incidence of morbidly adherent placenta is on the rise due to increase in the rates of caesarean section. We report a case of a 32-year-old, G2P1L1 who presented to us at 27 weeks in a state of haemodynamic shock with intrauterine fetal death. She had a history of prior caesarean section complicated by postpartum haemorrhage requiring B-Lynch suturing. With an initial diagnosis of caesarean scar rupture, she underwent an emergency laparotomy. Intraoperatively, the caesarean scar was found to be intact and uterine fundal rupture with placental protrusion identified. She underwent caesarean hysterectomy and was discharged in a stable condition. The histopathology report confirmed the diagnosis of placenta percreta.

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Williamson, Harriet, Radha Indusekhar, Alexander Clark, and Ismail M. Hassan. "Spontaneous Severe Haemoperitoneum in the Third Trimester Leading to Intrauterine Death: Case Report." Case Reports in Obstetrics and Gynecology 2011 (2011): 1–4. http://dx.doi.org/10.1155/2011/173097.

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Spontaneous haemoperitoneum during pregnancy is a rare but potentially catastrophic cause of acute abdominal pain. A healthy 37-year-old primigravida presented with acute abdominal pain and hypovolaemic shock at 37-weeks gestation. An emergency caesarean section was indicated on the clinical suspicion of placental abruption. However, an ultrasound scan confirmed the absence of a fetal heartbeat, and, in light of the mother’s haemodynamic stability, a vaginal delivery was deemed most appropriate. Subsequent imaging, due to deterioration over the following 24-hours, revealed a large heterogenous haematoma within the pelvic cavity, which was later found to be caused by severe pelvic endometriosis. Despite fertility problems associated with severe endometriosis, advanced assisted reproductive technology enables more of these patients to become pregnant, highlighting the need to be aware of this rare complication in pregnancy.

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Polglase, Graeme R., Stuart B. Hooper, Martin Kluckow, Andrew W. Gill, Richard Harding, and Timothy J. M. Moss. "The cardiopulmonary haemodynamic transition at birth is not different between male and female preterm lambs." Reproduction, Fertility and Development 24, no. 3 (2012): 510. http://dx.doi.org/10.1071/rd11121.

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Males born preterm are at greater risk of illness and death than females, principally due to respiratory disease. Much of the excess morbidity occurs within the first few hours of life. Therefore, the aim of the present study was to investigate whether or not differences in the cardiopulmonary transition soon after birth underlie the increased morbidity in males after preterm birth. Nine female and thirteen male lambs (128 ± 2 days gestation) underwent surgery immediately before delivery for implantation of a pulmonary arterial flow-probe and catheters into the main pulmonary artery and a carotid artery. After birth lambs were ventilated for 30 min (tidal volume 7 mL kg–1) while anaesthetised. Arterial pressures and flows were recorded in real time and left-ventricular output measured using Doppler echocardiography. Before birth, fetal cardiopulmonary haemodynamics, arterial blood gases, pH, glucose and lactate did not differ between sexes. Similarly, in the neonatal period there were no significant differences in arterial blood gas status, ventilation parameters, respiratory indices or cardiopulmonary haemodynamics between the sexes. Our data show that the cardiopulmonary transition at birth in ventilated, anaesthetised preterm lambs is not influenced by sex. Thus, the neonatal ‘male disadvantage’ is not explained by an impaired cardiovascular transition at birth.

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Weiner, Zeev, George Farmakides, Harold Schulman, Angela Casale, and Joseph Itskovitz-Eldor. "Central and peripheral haemodynamic changes in post-term fetuses: correlation with oligohydramnios and abnormal fetal heart rate pattern." BJOG: An International Journal of Obstetrics and Gynaecology 103, no. 6 (June 1996): 541–46. http://dx.doi.org/10.1111/j.1471-0528.1996.tb09803.x.

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Blank, Douglas A., Graeme R. Polglase, Martin Kluckow, Andrew William Gill, Kelly J. Crossley, Alison Moxham, Karyn Rodgers, et al. "Haemodynamic effects of umbilical cord milking in premature sheep during the neonatal transition." Archives of Disease in Childhood - Fetal and Neonatal Edition 103, no. 6 (December 5, 2017): F539—F546. http://dx.doi.org/10.1136/archdischild-2017-314005.

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ObjectiveUmbilical cord milking (UCM) at birth may benefit preterm infants, but the physiological effects of UCM are unknown. We compared the physiological effects of two UCM strategies with immediate umbilical cord clamping (UCC) and physiological-based cord clamping (PBCC) in preterm lambs.MethodsAt 126 days’ gestational age, fetal lambs were exteriorised, intubated and instrumented to measure umbilical, pulmonary and cerebral blood flows and arterial pressures. Lambs received either (1) UCM without placental refill (UCMwoPR); (2) UCM with placental refill (UCMwPR); (3) PBCC, whereby ventilation commenced prior to UCC; or (4) immediate UCC. UCM involved eight milks along a 10 cm length of cord, followed by UCC.ResultsA net volume of blood was transferred into the lamb during UCMwPR (8.8 mL/kg, IQR 8–10, P=0.01) but not during UCMwoPR (0 mL/kg, IQR −2.8 to 1.7) or PBCC (1.1 mL/kg, IQR −1.3 to 4.3). UCM had no effect on pulmonary blood flow, but caused large fluctuations in mean carotid artery pressures (MBP) and blood flows (CABF). In UCMwoPR and UCMwPR lambs, MBP increased by 12%±1% and 8%±1% and CABF increased by 32%±2% and 15%±2%, respectively, with each milk. Cerebral oxygenation decreased the least in PBCC lambs (17%, IQR 13–26) compared with UCMwoPR (26%, IQR 23–25, P=0.03), UCMwPR (35%, IQR 27–44, P=0.02) and immediate UCC (34%, IQR 28–41, P=0.02) lambs.ConclusionsUCMwoPR failed to provide placental transfusion, and UCM strategies caused considerable haemodynamic disturbance. UCM does not provide the same physiological benefits of PBCC. Further review of UCM is warranted before adoption into routine clinical practice.

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Reijnders, IF, AGMGJ Mulders, MPH Koster, ATM Kropman, AHJ Koning, SP Willemsen, EAP Steegers, and RPM Steegers‐Theunissen. "First‐trimester maternal haemodynamic adaptation to pregnancy and placental, embryonic and fetal development: the prospective observational Rotterdam Periconception cohort." BJOG: An International Journal of Obstetrics & Gynaecology 129, no. 5 (November 2, 2021): 785–95. http://dx.doi.org/10.1111/1471-0528.16979.

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Ratih kumala fajar apsari and Bambang Suryono Suwondo. "Emboli Air Ketuban." Jurnal Anestesi Obstetri Indonesia 1, no. 1 (April 14, 2020): 54–71. http://dx.doi.org/10.47507/obstetri.v1i1.25.

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Emboli cairan amnion (EAK) adalah komplikasi kehamilan yang jarang namun membawa angka mortalitas yang tinggi. Patogenesis yang tepat dari kondisi ini masih belum diketahui. Emboli air ketuban (EAK) atau amniotic fluid embolism (AFE) atau anaphylactoid syndrome of pregnancy adalah salah satu komplikasi kehamilan yang paling membahayakan. Cairan ketuban, debris fetal diduga menyebabkan kolaps kardiovaskular dengan cara memicu reaksi imun/anafilaktoid maternal. Patofisiologi EAK hingga kini masih belum jelas tetapi diduga melibatkan kaskade immunologis. Kematian maternal bisa terjadi karena cardiac arrest mendadak, perdarahan karena koagulopati, dan kegagalan organ multipel dengan acute respiratory distess syndrome (ARDS). Gejala dan tanda EAK antara lain dispnea akut, batuk, hipotensi, sianosis, bradikardia fetal, ensefalopati, hipertensi pulmoner akut, koagulopati, dan sebagainya. Diagnosis EAK adalah bersifat klinis dan ditegakkan setelah menyingkirkan kemungkinan penyebab lain. Penatalaksanaan bersifat suportif dan memerlukan persalinan janin jika diperlukan, support respiratorik, dan support hemodinamik. Prognosis maternal setelah EAK masih sangat buruk meski tingkat survival janin sekitar 70%. Pasien dengan EAK paling baik dikelola di unit perawatan kritis oleh tim multidisiplin dan dengan manajemen supportif. Amniotic Fluid Embolism Abstract Amniotic fluid embolism (AFE) is a rare complication of pregnancy carrying a high mortality rate. The exact pathogenesis of the condition is still not known. Amniotic fluid embolism (AFE) or anaphylactoid syndrome of pregnancy is one of the most dangerous pregnancy complications. Amniotic fluid, fetal debris is thought to cause cardiovascular collapse by triggering a maternal immune / maternal anaphylactoid reaction. The pathophysiology of AFE remains unclear but is thought to involve an immunological cascade. Maternal deaths may occur due to sudden cardiac arrest, bleeding due to coagulopathy, and multiple organ failure with ARDS. AFE symptoms and signs include acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy. Management is supportive, respiratory support, and haemodynamic support. The maternal prognosis is very poor even though the survival rate of the fetus is about 70%. Patients with AFE are best managed in a critical care unit by a multidisciplinary team and management is largely supportive

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Hartono, Ruddi, Sri Rahardjo, and Yusmein Uyun. "Low Dose Spinal Anesthesia Bupivakain 0,5% 5 mg dengan Adjuvan Fentanyl 50 mcg untuk Pasien dengan Uncorrected Tetralogy of Fallot yang Menjalani Seksio Sesarea." Jurnal Anestesi Obstetri Indonesia 2, no. 2 (April 12, 2020): 93–9. http://dx.doi.org/10.47507/obstetri.v2i2.15.

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Pasien hamil dengan uncorrected tetralogy of fallot yang menjalani seksio sesarea merupakan tantangan tersendiri bagi dokter anestesi. Tetralogy of Fallot terdiri dari ventricular septal defect, hipertrofi ventrikel kanan, overriding aorta dan stenosis pulmonal. Prinsip anestesi pada pasien ini adalah mempertahankan systemic vascular resistence (SVR) dan menghindari peningkatan pulmonary vascular resistance (PVR). Pasien Ibu hamil, 19 tahun dengan berat badan 50 kg, tinggi badan 150 cm, G3P000Ab200 Gravida 36–37 minggu, tunggal hidup, fetal distress dan tali pusat menumbung dengan tetralogy of fallot, akan dilakukan seksio sesarea cito. Penatalaksanaan anestesi pasien ini dengan low dose spinal anesthesia bupivakain 0,5% 5 mg dan adjuvan fentanyl 50 mcg. Hemodinamik stabil setelah tindakan spinal. Tekanan darah sebelum dilakukan spinal 100/60 mmHg dengan laju nadi 67 kali per menit dan saturasi oksigen 80% menggunakan non rebreathing mask (NRBM) 10 liter per menit. Tekanan darah pada saat operasi dimulai adalah 96/57 mmHg dan laju nadi 77 kali per menit serta saturasi 78% menggunakan NRBM 10 liter per menit. Setelah bayi dilahirkan, hemodinamik stabil hingga akhir operasi, tidak ditemukan periode hipotensi yang berat dan tidak digunakan obat vasopressor selama operasi. Pasien dipindahkan ke ICU untuk observasi pasca operasi selama 2 hari. Selama perawatan di ICU, kondisi pasien tetap stabil dan kemudian dipindahkan ke ruang perawatan biasa. Low dose spinal anesthesia mencegah risiko hipotensi karena intensitas blok simpatis yang lebih minimal sehingga penurunan SVR dapat dihindari. Teknik ini dapat digunakan sebagai alternatif pembiusan pada pasien dengan tetralogy of fallot tetapi tergantung kondisi pasien saat akan dilakukan pembiusan. Low Dose Spinal Anesthesia Bupivacaine 0,5% 5 mg with Adjuvant Fentanyl 50 mcg for Cesarean Section Patient with Uncorrected Tetralogy of Fallot AbstractCesarean delivery in parturient with uncorrected tetralogy of fallot poses significant challenge for anesthesiologist. Tetralogy of Fallot consists of ventricular septal defect, right ventricular hypertrophy, overriding aorta and stenosis pulmonum. Main principle of anesthesia for tetralogy of fallot is maintenance of systemic vascular resistance dan avoidance of increasing pulmonary vascular resistance. Parturient, 19 years old, body weigt 50 kg, height 150 cm, G3P000Ab200 36 – 37 weeks, fetal distress and umbilical cord prolapse with tetralogy of fallot will perform cesarean section. Patient anesthesized with low dose spinal anesthesia using bupivacaine 0,5% 5cmg with adjuvant fentanyl 50 mcg. Haemodynamic before spinal with blood pressure is 100/60 mmHg, heart rate 67 beat per minute (BPM), saturation is 80% using 10 liter of oxygen non rebreathing mask (NRBM) . Blood pressure during incision 96/57 mmHg heart rate 77 BPM with saturation 78% using 10 liter of NRBM. Haemodynamic is stable after baby is born until the operation is done, without any episode of severe hypotension and there is no using of vasopressor drugs. Patient is moved to ICU after the operation for further observation and for 2 days periode the haemodynamic is stable and then patient is moved to regular ward. Low dose spinal anesthesia avoid the incidence of hypotension by causing less intense blocked sympathetic system than traditional dose and thus providing a stable SVR. This technique could be an alternative for anesthesizing for parturient with tetralogy of fallot but its depend on patient condition before operation.

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