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Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(2):71-75; doi:10.1093/bjaceaccp/mkn004
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Fetal surgery and anaesthetic implications

Ritu Gupta, MB ChB FCARCSI, Mark Kilby, MBBS MD MRCOG and Griselda Cooper, OBE FRCA FRCOG
Specialist Registrar
Department of Anaesthesia
Queen Elizabeth Hospital
Edgbaston
Birmingham B15 2TH
UK
Dame Hilda Lloyd Professor of Maternal and Fetal Medicine
Birmingham Women's Hospital
University of Birmingham
Metchley Park Road
Edgbaston
Birmingham B15 2TG
UK
Consultant Anaesthetist
Department of Anaesthesia
Queen Elizabeth Hospital
Edgbaston
Birmingham B15 2TH
UK
Tel: +44 121 627 2060 Fax: +44 121 627 2062 E-mail: gcooper@rcanae.org.uk

Key Words: Fetal surgery is performed in specialist centres and requires multidisciplinary teamwork. • In addition to obstetric anaesthetic considerations, the anaesthetist needs to be conversant with tocolytic methods. • Fetal analgesia is required for some procedures. • The use of fetoscopic procedures is increasing; however, presently, only laser ablation of placental vessels is of proven efficacy.

The first 150 words of the full text of this article appear below.

Surgery to the fetus while it is still in utero is used to treat an increasing number of lethal and non-lethal conditions. The problems of preterm labour and premature rupture of membranes associated with open surgery have led to the development of minimal access surgical techniques. Although fetal surgery is a new and fast moving frontier of medicine, it is not one that all obstetric anaesthetists will encounter. The first successful human fetal operation was performed in 1983, but it is still only carried out in a limited number of specialist tertiary centres.

The broad challenges presented to the anaesthetist are:

  1. those related to any anaesthetic in a pregnant woman;
  2. techniques used to prevent preterm labour;
  3. maintenance of maternal homeostasis in the face of tocolytic techniques;
  4. maintenance of fetal homeostasis;
  5. provision of fetal analgesia during surgery;
  6. distance the mother may need to travel from home.
It is expected that the . . . [Full Text of this Article]


   Twin–twin transfusion syndrome
 

   Congenital diaphragmatic hernia
 

   Ex utero intrapartum treatment procedure
 

   Obstructive uropathy
 

   Myelomeningocele
 

   Tocolysis
 

   Fetal stress
 

   Fetal analgesia
 

   Complications
 

   Social factors
 

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