The range of surgical interventions possible during pregnancy is increasing and, as a result, so is the demand for antenatal anaesthesia. Anaesthesiologists must be constantly vigilant about the potential effects of potent anaesthetic drugs on the unborn patient and on long-term development of the child after birth.
Anesthesia & the Fetus fuses the multidisciplinary and international components of foetal development; foetal pharmacology; assessments of foetal outcome; anaesthesia during pregnancy; anaesthesia during labour; and ethics and law
The wisdom distilled from this mixture provides a contemporary guide and reference to the role of anaesthesia, and the anaesthesiologist, in protecting the mother and her unborn child from harm.
• Focuses on the foetus – a unique but essential approach.
• Uses foetal and neonatal outcomes as the basis for assessing the effects of anaesthetic interventions during pregnancy.
• Concise practical guide backed up by theoretical considerations.
• Discusses wider ethical and legal considerations. Contributors, ix

Preface, xvi

Acknowledgments, xviii

Section I: Basic Principles

1 Intrauterine growth and development, 3
Timothy Moss, Cheryl Albuquerque & Richard Harding

2 Maternal physiological adaptations to pregnancy, 19
Julie Phillips, MD, Melissa Covington, MD & George Osol, PhD

3 Placental respiratory gas exchange, 25
Lowell Davis

4 The fetal circulation, 32
Loren P. Thompson, PhD & Kazumasa Hashimoto, MD

5 Fetal responses to hypoxia, 39
Tania L. Kasdaglis, MD and Ahmet A. Baschat MD

6 Pharmacokinetics in pregnancy, 53
Janine R Hutson, MSc, Chagit Klieger-Grossmann MD & Gideon Koren MD, FRCPC, FABMT

7 The first few breaths: normal transition from intra- to extra-uterine life, 63
Smadar Eventov-Friedman, MD/PhD & Benjamin Bar-Oz, MD

Section II: Endpoint Variables: Assessments of Fetal Wellbeing and Neonatal Outcome

8 Validity of endpoint measurement, 75
Pamela Angle MD MSc, FRCPC, Stephen Halpern MD MSc, FRCPC, Marcos Silva MD & Alex Kiss PhD

Section III: Antenatal and Intrapartum Assessment of the Fetus

9 Imaging of the fetus and the uteroplacental blood supply: ultrasound, 89
Kypros Nicolaides

10 Imaging of the fetus and the uteroplacental blood supply: MRI, 97
Caroline Wright & Philip Baker

11 Fetal heart rate monitoring, 104
Alison M. Premo & Sarah J. Kilpatrick

12 Fetal acid-base monitoring, 114
Lennart Nordström

13 Fetal pulse oximetry, 123
Paul B Colditz & Christine East

14 Neonatal assessment and prediction of neonatal outcome, 129
Vadivelam Murthy & Anne Greenough

Section IV: Interventions: anesthesia, analgesia, and their effects on the fetus

15 Environmental exposure to anesthetic agents, 141
Asher Ornoy, MD

16 Anesthesia and analgesia for assisted reproduction techniques and during the first trimester, 147
Arvind Palanisamy, MD, FRCA & Lawrence C. Tsen, MD

17 The effect of anesthetic drugs on the developing fetus: considerations in non-obstetric surgery, 156
Richard S. Gist MD CDR MC USN & Yaakov Beilin MD

18 Substance abuse and pregnancy, 165
Donald H. Penning MD, MS, FRCP & Allison J. Lee, MD

19 Intrauterine fetal procedures for congenital anomalies, 173
Amar Nijagal MD, Hanmin Lee MD & Mark Rosen MD

20 The EXIT procedure, 183
Sheldon M. Stohl, MD, Hindi E. Stohl, MD, Ari Y. Weintraub, MD & Kha M. Tran, MD

21 Mechanisms and consequences of anesthetic-induced neuroapoptosis in the developing brain, 192
Zhaowei Zhou, Adam P Januszewski, Mervyn Maze & Daqing Ma

22 Relevance to clinical anesthesia of anesthetic-induced neurotoxicity in developing animals, 200
Catherine E. Creeley, Mervyn Maze & John W. Olney

23 External cephalic version, 210
Carolyn F. Weiniger MB ChB & Yossef Ezra MD

Section V: Anesthesia for Cesarean Delivery

24 Effects on the fetus of general versus regional anesthesia, 217
Sharon Orbach-Zinger MD and Yehuda Ginosar BSc MBBS

25 Anesthesia for cesarean delivery: effects on the fetus of maternal blood pressure control, 235
ProfessorWarwick D. Ngan Kee, BHB, MBChB, MD, FANZCA, FHKCA, FHKAM

26 Effects on the fetus of maternal oxygen administration, 244
Neeti Sadana, MD and Scott Segal, MD, MHCM

27 Effects on the fetus of maternal position during cesarean delivery, 251
Robin Russell MB BS MD FRCA

Section VI: Analgesia for labor

28 Effects on the fetus of systemic vs. neuraxial analgesia, 263
Stephen H. Halpern MD, MSc, FRCPC & Marcos Silva MD

29 The effects on the fetus of early versus late regional analgesia, 270
Cynthia A. Wong, MD 270

30 Regional analgesia, maternal fever, and its effect on the fetus and neonate, 277
Tabitha A. Tanqueray, Philip J. Steer & Steve M. Yentis

31 Effects on the fetus of major maternal anesthetic complications, 285
Felicity Plaat MA MBBS FRCA & Ruth Bedson MBBS FRCA

Section VII: Confounding Variables: The Compromised Fetus, the Compromised Mother

32 Twins and higher order multiple pregnancies: implications for the anesthesiologist, 295
Y. Habaz, J. Barrett & E.S. Shinwell

33 Preeclampsia: the compromised fetus, the compromised mother, 301
Henry L. Galan, MD & Todd R. Lovgren, MD

34 Fetal distress, 313
Robert A Dyer, FCA (SA), PhD & Leann K Schoeman, FCOG (SA)

Section VIII: Trauma and Resuscitation

35 Maternal trauma, 325
Yuval Meroz MD, Uriel Elchalal, MD & Avraham I Rivkind, MD FACS

36 Maternal resuscitation and perimortem cesarean delivery, 333
Sharon Einav, MD, Sorina Grisaru-Granovski, MD, PhD & Joseph Varon MD, FACP, FCCP, FCCM

37 Fetal resuscitation, 343
Stephen Michael Kinsella & Andrew Shennan

38 Neonatal resuscitation and immediate neonatal emergencies, 350
Ritu Chitkara, MD, Anand K. Rajani, MD & Louis P. Halamek, MD

Section IX: Medicine, Ethics, and the Law

39 Fetal beneficence and maternal autonomy: ethics and the law, 363
William J. Sullivan, QC & M. Joanne Douglas, MD, FRCPC

40 Maternal-fetal research in pregnancy, 372
Frank A. Chervenak, MD & Laurence B. McCullough, PhD

Index, 379
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