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Maternal and fetal cardiovascular and metabolic effects of intra-operative uterine handling under general anesthesia during pregnancy in sheep.

Accepted version
Peer-reviewed

Type

Article

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Authors

Shaw, Caroline J 
Botting, Kimberley J 
Niu, Youguo 
Lees, Christoph C 
Giussani, Dino A 

Abstract

A cohort study of 6,500,000 human pregnancies showed an increased risk of adverse fetal outcomes following abdominal but not non-abdominal surgery under general anesthesia. This may be the consequence of uterine handling during abdominal surgery. However, there are no data on any effects on the cardiometabolic physiology of the fetus or mother in response to uterine manipulation in otherwise healthy pregnancy. Consequently, 9 sheep in late gestation were anesthetized with isofluorane and maternal and fetal catheters and flow probes were implanted to determine cardiovascular and metabolic changes during uterine handling. Uterine handling led to an acute increase in uterine artery vascular resistance, fetal peripheral vasoconstriction, a reduction in oxygen delivery to the femoral circulation, worsening fetal acidosis. There was no evidence of systemic fetal hypoxia, or changes in fetal heart rate, carotid blood flow or carotid oxygen delivery. Therefore, the data support that uterine handling during abdominal surgery under general anesthesia can impact adversely on fetal cardiometabolic health. This may provide a potential explanation linking adverse fetal outcomes in abdominal compared with non-abdominal surgery during pregnancy. The data have important implications for human fetal surgery where the uterus is handled, as operative procedures during late gestation under general maternal anesthesia become more prevalent.

Description

Keywords

Anesthesia, General, Animals, Cardiovascular System, Female, Fetal Diseases, Fetal Hypoxia, Intraoperative Care, Pregnancy, Regional Blood Flow, Sheep, Uterus, Vascular Resistance

Journal Title

Sci Rep

Conference Name

Journal ISSN

2045-2322
2045-2322

Volume Title

10

Publisher

Springer Science and Business Media LLC

Rights

All rights reserved
Sponsorship
British Heart Foundation (None)
British Heart Foundation (None)
Action Medical Research (via Imperial College London) (WS/ 3074260)
British Heart Foundation (RG/17/8/32924)
Action Medical Research (via Imperial College London) (p70869)
MRC (via Imperial College London) (P70869)
Action Medical Research GN2052 The British Heart Foundation RG/17/8/32924