Fetal Surgery

Advances in prenatal diagnosis with the use of modern technology (ultrasonography, fetal echocardiography, fetal MRI, amniocentesis, umbilical blood sampling, and chorionic villus sampling) and the development of open fetal surgical techniques now permit the treatment of fetal conditions that would otherwise have caused progressive, irreversible damage and possible intrauterine fetal demise if left untreated.^[289] Such abnormalities include congenital diaphragmatic hernia, hydronephrosis, twin-twin transfusion syndrome, and hydrothorax.

It is important for the anesthesiologist to understand the fetal lesion and the surgical approach because they determine the type of anesthetic care offered to the mother. Key issues for the anesthesiologist include maternal safety, uterine relaxation, fetal immobility, and anesthesia. Intensive monitoring of uterine activity and the use of tocolytic agents (such as the volatile agents terbutaline and nitroglycerin) are often necessary to prevent the associated high risk of premature labor. Mothers have an increased risk of pulmonary edema in the postoperative period as a result of aggressive tocolytic therapy; thus, close attention to fluid balance is warranted.