Nonobstetric surgery during pregnancy скачать в хорошем качестве

Nonobstetric surgery during pregnancy

Key Fetal Risks During Nonobstetric Surgery: Main risks: maternal hypoxemia, hypotension, acidosis, hyperventilation/alkalosis Additional risks: fetal loss, preterm labor, growth restriction, low birth weight, teratogenicity Important Interventions (starting 18-20 weeks): 1. Aspiration precautions (H2 blockers, nonparticulate antacids) 2. Left uterine displacement to prevent aortocaval compression 3. For preterm labor: can use β2-agonists, Ca channel blockers, magnesium as tocolytics To reduce risk of fetal complications during laparoscopic surgery: -lower insufflation pressures (e.g. 10-15 mm Hg) to prevent a decrease in uterine perfusion -maintain mild hypocarbia (EtCO2 of 32-36 mm Hg) to prevent fetal acidosis due to an increased PaCO2 to ETCO2 gradient during insufflation Surgical Timing: Best to defer elective surgery until after delivery Second trimester has lowest balanced risk First trimester: highest risk of abnormal fetal organogenesis Third trimester: highest risk of premature labor Medication Notes: Consider avoiding: (based on animal studies) Benzodiazepines (especially midazolam) Cocaine Nitrous oxide (long exposure/high concentrations) Esmolol (can cause fetal bradycardia) Ketamine over 2mg/kg in first two trimesters (uterine hypertonus)