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Critical Care Obstetrics part 72

Critical Care Obstetrics part 72 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | 49 Fetal Surgery Procedures and Associated Maternal Complications Robert H. Ball1 Michael A. Belfort2 1HCA Fetal Therapy Initiative St Mark s Hospital Salt Lake City and Division of Perinatal Medicine and Genetics Departments of Obstetrics Gynecology and Reproductive Sciences UCSF Fetal Treatment Center University of California San Francisco CA USA 2Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine University of Utah Salt Lake City UT and HCA Healthcare Nashville TN USA Introduction A discussion of the potential maternal complications of fetal surgery is pertinent given the fact that such complications are in theory absolutely avoidable. As the term suggests fetal surgery is performed for the sole physical benefit of the fetus and any risk to which the mother is exposed is for a purely altruistic purpose. There is no direct health benefit to the mother. Many of the first fetal surgical procedures depended on maternal laparotomy to expose the uterus and hysterotomy to expose the fetus. This approach then evolved into laparotomy with uterine endoscopy rather than hysterotomy to preserve the integrity of the uterus. With further experience laparotomy has been for the most part been replaced with percutaneous procedures using telescopic devices with a diameter of 3 mm or less. The progression to microinvasive fetoscopic approaches has reduced the potential for morbidity but not eliminated it 1 Table 49.1. . Each one of these approaches and associated complications will be discussed in more detail below. Hysterotomy Hysterotomy while less frequently used now is still employed in some cases where endoscopic techniques are not possible. These include repair of neural tube defects and the removal of sacrococcygeal teratomas and other masses. Hysterotomy-based procedures are usually dependent on intraoperative ultrasound guidance both before and after abdominal wall incision . Once the patient has had anesthesia general endotracteal and the sterile