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Chapter 28 - Anesthesia for Rare Fetal and Placental Conditions

Published online by Cambridge University Press:  26 January 2024

By
Marla B. Ferschl  and
Mark D. Rollins
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Grace Lim
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Grace Lim
Affiliation:
University of Pittsburgh
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Summary

In utero intervention for fetal anomalies or abnormal placentation should only occur for conditions known to result in ongoing irreversible harm to the fetus or increased risk to the mother. For in utero fetal treatment procedures there should be evidence that potential harm from the fetal lesion is best mitigated by intervention at a gestational age with superior outcomes than ex utero neonatal treatment. Although most fetal anomalies are not amenable to in utero treatment, two conditions with significant evidence of improved outcomes include use of fetoscopic laser photocoagulation to treat twin-to-twin transfusion syndrome and mid-gestational in utero open fetal surgery to treat myelomeningocele. Minimally invasive fetal treatment techniques are typically performed under local or regional anesthesia, while open fetal procedures are done under general anesthesia. Successful fetal intervention requires extensive multidisciplinary planning and collaboration. In addition to anesthetic considerations employed for nonobstetric surgery during pregnancy, fetal anesthesia and analgesia, fetal monitoring, uterine relaxation, and preparation for emergent maternal and fetal events are all necessary. Future research into anesthetic techniques for various maternal-fetal procedures is key to optimizing clinical outcomes and advancing the field of fetal surgery and maternal-fetal medicine.

Keywords

fetal surgeryEXIT procedurefetal physiologyfetal painfetal treatmentfetal anesthesiafetal monitoringmaternal-fetal anesthesiaabnormal placentationtwin-to-twin transfusionmyelomeningocele
Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 456 - 468
Publisher: Cambridge University Press
Print publication year: 2024

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