Evaluation of fetal and uterine hemodynamics during maternal cardiopulmonary bypass

Meena Khandelwal, Juha Rasanen, Avi Ludormirski, Paul Addonizio, E. Albert Reece

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: About 4% of pregnant women have concomitant cardiac disease and a few of these do not respond to medical therapy and require surgical correction during pregnancy. We report a unique case describing fetal hemodynamics and uterine blood flow before, during, and after maternal cardiopulmonary bypass, and compare them to normal reference values in the second trimester. Case: A woman with severe aortic regurgitation underwent aortic valve replacement at 19 weeks' gestation. A nonpulsatile cardiac pump was used for cardiopulmonary bypass, maintaining the mean arterial pressure at 77-90 mmHg, with a peak flow rate of 3.5-4.0 L/minute/m2 and core temperature of 34-35C throughout surgery. Blood velocity waveforms were recorded by Doppler ultrasound at the level of maternal main uterine artery and fetal vessels. Pulsatility index (PI) values were calculated. Preoperatively, fetal hemodynamic characteristics were within normal limits. Preoperatively, uterine artery PI was 3.9 (normal 0.5-1.5 at 20 weeks). Intraoperatively, fetal bradycardia ensued after aortic clamping (120 to 75 beats per minute), with a rise in umbilical artery PI (1.7 to 7.1) and disappearance of diastolic flow. The middle cerebral artery PI decreased (2.0 to 0.92) and the PI increased in the descending aorta (2.22 to 3.55), inferior vena cava (2.7 to 9.3), and ductus venosus (0.6 to 1.7). During bypass, after aortic clamping, nonpulsatile uterine artery flow was noted. Postoperatively, the uterine artery PI improved, to 1.0. Two days later, hydrocephalus and hydrops were observed. Conclusion: Despite high peak flow rates, normal mean arterial pressure, and normothermia, fetal outcome was dismal. Nonpulsatile cardiopulmonary bypass under normothermia may not be able to meet the demands of the fetoplacental circulation.

Original languageEnglish (US)
Pages (from-to)667-671
Number of pages5
JournalObstetrics and Gynecology
Volume88
Issue number4 II SUPPL.
DOIs
StatePublished - Oct 1996
Externally publishedYes

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Uterine Artery
Cardiopulmonary Bypass
Hemodynamics
Mothers
Constriction
Arterial Pressure
Reference Values
Placental Circulation
Doppler Ultrasonography
Pregnancy
Umbilical Arteries
Aortic Valve Insufficiency
Middle Cerebral Artery
Inferior Vena Cava
Second Pregnancy Trimester
Hydrocephalus
Bradycardia
Thoracic Aorta
Aortic Valve
Pregnant Women

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Khandelwal, M., Rasanen, J., Ludormirski, A., Addonizio, P., & Reece, E. A. (1996). Evaluation of fetal and uterine hemodynamics during maternal cardiopulmonary bypass. Obstetrics and Gynecology, 88(4 II SUPPL.), 667-671. https://doi.org/10.1016/0029-7844(96)00129-9

Evaluation of fetal and uterine hemodynamics during maternal cardiopulmonary bypass. / Khandelwal, Meena; Rasanen, Juha; Ludormirski, Avi; Addonizio, Paul; Reece, E. Albert.

In: Obstetrics and Gynecology, Vol. 88, No. 4 II SUPPL., 10.1996, p. 667-671.

Research output: Contribution to journalArticle

Khandelwal, M, Rasanen, J, Ludormirski, A, Addonizio, P & Reece, EA 1996, 'Evaluation of fetal and uterine hemodynamics during maternal cardiopulmonary bypass', Obstetrics and Gynecology, vol. 88, no. 4 II SUPPL., pp. 667-671. https://doi.org/10.1016/0029-7844(96)00129-9
Khandelwal, Meena ; Rasanen, Juha ; Ludormirski, Avi ; Addonizio, Paul ; Reece, E. Albert. / Evaluation of fetal and uterine hemodynamics during maternal cardiopulmonary bypass. In: Obstetrics and Gynecology. 1996 ; Vol. 88, No. 4 II SUPPL. pp. 667-671.
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