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Category: Fetus
Poster Session IV
FSR using heated humidified carbon dioxide (hCO2) gas for uterine insufflation, has been associated with improved maternal morbidity compared to OSR. Fetal cardiovascular changes during these procedures are not well defined. Our objective was to quantify and compare fetal UA physiology during the stages of both surgical procedures.
Study Design:
A prospective cohort study of 28 consecutive FSR was compared to 22 OSR. Both groups had similar anesthesia. UA Doppler were systematically obtained at all stages of perioperative and preoperative period with an angle of insonation at < 15°. Fetal heart rate (FHR), end diastolic flow (EDF) and pulsatility index (PI) were recorded. During the intra-operative periods, the measurements were taken every 5 minutes and were segmented into hourly durations. The lowest FHR per patient was used for analysis. Repeated measure ANOVA evaluated these changes.
Results:
Gestational age at surgery was similar in both groups(p=0.3). The total operative time in FSR was significantly longer (259 ± 36min) compared to OSR (144 ± 21 min, p< 0.0001). FHR decreased gradually in both groups after general anesthesia, and further during the intra-operative period (Figure 1). The FHR was significantly lower at 2 hours of surgery and immediately prior to maternal extubation in the FSR compared to OSR (p= 0.005 and 0.01, respectively). EDF decreased in both groups, but was more severe in the FSR group who recovered slower than OSR (Figure 2A). There was no change in PI in OSR, however, there was a significant elevation in the PI in FSR (Figure 2B). The rate of absent EDF in UA in the FSR Dopplers was 28% (n=8) compared to 13% (n=3) in the OSR group (p=0.2). A FHR < 110 in the FSR group was 39% (n=11) compared to 27% (n=6) the OSR group (p=0.3). Fetal rescue rates in the FSR group were 17% (n=5) vs.13% (n=3) in the OSR group (p=0.7).
Conclusion:
Both approaches for in-utero spina bifida repair resulted in significant changes in fetal cardiovascular homeostasis, which presented as low heart rate and decreased placental flow. However, FSR led to more significant decreases in fetal heart rate.
Sami Backley, MD
Clinical Fellow PGY 6
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Jeannine Garnett, PhD (she/her/hers)
Program Manager, Research - Ob/Gyn Maternal Fetal Medicine
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, TX, United States
Edgar Hernandez Andrade, MD
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Eric P. Bergh, MD
Assistant Professor
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Ranu Jain, MD
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Kuojen Tsao, MD
Chief of Pediatric Surgery
Pediatric Surgery and Pediatric Surgical Critical Care McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Mary Austin, MD
Pediatric Surgeon
Pediatric Surgery and Pediatric Surgical Critical Care McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Stephen A. Fletcher, DO
Neurosurgery, Pediatric Neurosurgery
Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Brandon Miller, MD, PhD
Assistant Professor, Division Of Pediatric Neurosurgery
UT Health Houston McGovern Medical School
Houston, Texas, United States
Brittany Graham, MD
Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston
Houston, Texas, United States
Heinrich Taegtmeyer, MD, PhD
Professor
Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston.
Houston, Texas, United States
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Anthony Johnson, DO
Professor
Division of Fetal Intervention, The Fetal Center at Children's Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Lovepreet Mann, MBBS
Division of Maternal-Fetal Medicine, The Fetal Center at Children's Memorial Hermann Hospital, Department of Obstetrics, Gynecology and Reproductive Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States
Ramesha Papanna, MD, MPH
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, Texas, United States