FETAL AND UTERINE answer DURING MAT...

FETAL AND UTERINE answer DURING MATERNAL SURGERY J M Kendrick American Journal of Maternal Child Nursing Vol 19 (May/June 1994) 165-170

The incidence of nonobstetric surgery requiring anesthesia during pregnancy is 02% to 22% and approximately 50000 women are affected in the United States by year. Perioperative monitoring of the fetus and uterine activity remains a matter of disputation Few studies support the appropriateness and feasibility of fetal heart rate (FHR) monitoring during nonobstetric surgical conducts In spite of improvements in surgical techniques and anesthesia, little has been written about fetal and uterine answer during nonobstetric surgery. Fetal heart rate monitoring may allow rapid improvement of fetal status or uterine activity should early compromise or contractions be ascertained The purpose of this subject of attention was to assess and describe FHR changes and uterine activity that take place during nonobstetric surgery in women at 20 to 40 weeks gestation; to determine whether infant birth weights were lower when the mother underwent surgery during pregnancy; and to determine the value of fetal monitoring during nonobstetric surgery

Methodology. A multiple case descriptive design and a convenience, nonprobability sample was used. Ten pregnant women meeting inclusion criteria participated. Inclusion criteria consisted of women with a fetus at 20 to 40 weeks gestation, nonemergent however necessary surgery, regional or general anesthesia, physician's order for fetal monitoring, and availability of the investigator. The consideration was conducted at a single site tertiary facility.

Data were garner uped using chart reviews, patient interviews, and participant-observer parts during the procedure. Fetal and uterine monitoring was performed using an external ultrasonic transducer and tocodynamometer, which were initiated preoperatively to establish baseline. Monitoring was continued during phase individual recovery unless an extended time frame was indicated (eg uterine contractions).

During abdominal surgery a sterile aquasonic gel and sleeve were used and held in place at the investigator who was scrubbed. In measures where more than one contraction occurr each 10 minutes, the obstetrician or perinatalogist was notified if IV hydration did not decrease activity. Prophylactic tocolytic medications were administered before the disclosure of cervical change because these bring under rules were at higher risk of preterm labor. To determine whether fetal birth weights were affected, they were compared to fetal birth weights of infants delivered previously to the same subject

springs Subjects ranged in age from 19 to 36 years (M = 248) with a mean gestation of 239 weeks (20 to 356 weeks). Seven of the make subordinates were multigravidas. Six were in the other trimester, and four were in the third trimester. The longitudinal dimensions of surgery ranged from 15 minutes to 3 hours and 50 minutes (M = 103 minutes). There was a significant difference in the duration of surgery and anesthesia (M = 2713 minutes, 10 to 50 minutes) because anesthesia was begun before an incision was made.

Contractions each two to three minutes (ie, uterine activity) were noted in one-half of the subdues Four of those subjects underwent abdominal surgery Intravenous tocolytic medications were required to reduce uterine activity in three make subordinates and IV hydration was required to melt uterine activity in one make subordinate Three subjects experienced preterm labor, moreover none delivered preterm.

Deceleration of FHR was noted during nine of the deeds and variability from baseline was noted in all make submissives Decreases in FHR (eg, 10 to 25 beats for minute) were significant in eight of the performances where subjects received general anesthesia. In the same subject who underwent a cholecystectomy at 21 weeks gestation with general anesthesia, protracted deceleration of FHR before detection of maternal hypotension was observed

Fetal birth weights were compared to those of the subject's other children. There was no significant difference at the 01 horizontal using the Wilcoxon signed rank test

Limitations. It is not possible to generalize these findings because of the small sample size and the use of a single site for data collection. In addition, external monitoring is not as accurate as internal monitoring; however, the use of internal monitoring is contraindicated since it necessitates break of the membranes, rendering the investigation unethical. Only one investigator performed intraoperative monitoring, and this could alter the findings should the thought be replicated. Also, the fact that no succeeding research regarding this topic has been published should be considered a limitation as well.

Perioperative implications. Despite the limitations of this contemplation in nine out of 10 make subordinates FHR changes were noted, and four of the make subordinates required tocolytic medications for significant uterine activity. These findings indicate there is a need to monitor FHR and uterine activity during nonobstetric surgery for patients at 20 weeks or greater gestation. Perinatal give suck tos have knowledge and education in this area, and this application of mind demonstrates that they have an intraoperative character to play in the care of this patient population and can best provide information about the fetus' and mother's rejoinder to nonobstetric surgery to the surgical team. It is the perinatal succor who is best positioned to collaborate in providing comprehensive nursing care to the two patients (ie, fetus and mother).