Considerations during pregnancy. There are a number of things to take into account to ensure the health and well-being of a mother-to-be and her child. Obstet Gynecol Surv. Feb;68(2) doi: /OGX. 0bef Stress: pregnancy considerations. Cardwell MS(1). Author information. The more we understand about the human microbiome, the more fundamental it seems. Pregnancy, birth, and breastfeeding seed a child's microbiome, and.
Pick Up a Copy Near You. Find Your Gathering Group. The protocol the researchers are using is: Take a piece of gauze soaked in sterile normal saline.
Remove swab just prior to surgery; store it in a sterile container. If you give birth in a hospital, use your own linen from home for your baby. Probiotics may also benefit babies suffering from colic. Issue 52 - Winter A Message from our Editor: Pathways to Family Wellness magazine, Issue Concerns about anaesthetic effects on the developing human fetus have been considered for many years.
Despite years of animal studies and observational studies in humans, no anaesthetic drug has been shown to be clearly dangerous to the human fetus and there is no optimal anaesthetic technique. The search for a clear answer is hampered by the fact that it would not be ethical to conduct a randomized trial on pregnant patients and no animal model perfectly mimics human gestation.
Timing of exposure is crucial because during the first 15 days of human gestation, an all-or-nothing phenomenon occurs: Tuchmann-Duplessis 26 in the s found that major congenital malformations were most likely to occur from exposures between days 13 and 60 in human embryos.
Multiple case—control studies have investigated the risk for birth defects in the offspring of women who had surgery and anaesthesia during pregnancy. While the anaesthetic drugs used and the stage of gestation varied, overall no study has shown excess birth defects in children of women who underwent surgery during pregnancy, but most have shown a small increase in the risk of miscarriage or preterm delivery.
However, the enhanced risk of preterm labour after abdominal and pelvic surgeries suggests that mechanical perturbation, local inflammation, or both are risk factors. Of pregnant women, 0. There was no difference between surgical and control patients with regard to the incidence of stillbirth or the overall incidence of congenital anomalies.
Clearly, only necessary surgery should be done during pregnancy. When possible, a regional technique is preferred due to consideration of the maternal airway and limiting fetal drug exposure. Nitrous oxide affects DNA synthesis and has teratogenic effects in animals.
These studies were highly confounded and the quantity of exposure was not known. Two studies have made a more convincing link between exposure to unscavenged nitrous oxide and reduced fertility in medical personnel. Several studies of nitrous oxide exposure in modern hospital settings with scavenging systems in place have failed to show an association between nitrous oxide use and adverse pregnancy outcome. Small case—control studies of benzodiazepine use in pregnancy suggested an association with cleft palate and cardiac anomalies; however, more recent, better controlled studies have refuted this association.
However, subtle associations cannot be ruled out. A recent meta-analysis evaluated 54 of publications that met their inclusion criteria, which included 12 women having surgery during pregnancy. Recent studies showing accelerated neuronal apoptosis in immature rodent brains exposed to anaesthetic agents with associated behavioural anomalies in the offspring has raised considerable concern about the standard practice of anaesthesia.
NMDA and GABA receptors are widely distributed throughout the central nervous system and are necessary for neuronal synaptogenesis, differentiation, and survival during development. Although evidence for anaesthetic-induced neuronal apoptosis in rodents is convincing, it is less clear that these data can be extrapolated to humans. General anaesthetic drugs inhibit synaptic transmission. However, this phase of rapid synaptogenesis occurs in rodents shortly after birth, but in humans, it extends from mid-gestation to several years after birth.
The extended period of synaptogenesis in humans could confer protection against persistent behavioural effects of perinatal anaesthetic exposure because the duration of anaesthetic exposure is only for a brief fraction of the vulnerable period. From a developmental perspective, exposing an infant rat to isoflurane for 6 h is roughly the equivalent of producing general anaesthesia for several weeks in a human neonate. Consulting perioperative physicians commonly concludes with a recommendation to avoid hypoxia and hypotension.
While this imperative is a foundation of anaesthetic practice, it is particularly important to the maternal—fetal unit during non-obstetric surgery. Short periods of mild hypoxaemia are well tolerated, 45 but prolonged or serious maternal hypoxaemia causes uteroplacental vasoconstriction and decreased uteroplacental perfusion that can result in fetal hypoxaemia, acidosis, and death.
Severe fetal respiratory acidosis causes myocardial depression. Hypercapnia also causes uterine artery vasoconstriction and reduced uterine blood flow.
Maintenance of normal maternal systemic arterial pressure is of great importance because of the relative passive dependence of the uteroplacental circulation.
Under normal circumstances, the spiral arteries are maximally dilated. Except under unusual circumstances such as severe maternal renal or cardiac disease, i.
Contrary to past recommendations, both ephedrine and phenylephrine are considered safe and effective pressors for control of maternal arterial pressure during pregnancy. From 18 to 22 weeks, fetal heart rate monitoring is practical, and from 25 weeks, heart rate variability can be readily observed.
Outcome data supporting continuous monitoring in normal delivery are not yet available. In the setting of general anaesthesia, loss of fetal heart rate variability is not always an indicator of fetal distress, but may simply be an indication of expected anaesthetic effects on the fetal autonomic nervous system. Slowing of the fetal heart rate in the operative setting is more concerning for fetal hypoxaemia and acidosis, but could also be related to a decrease in temperature, maternal respiratory acidosis, or the administration of drugs, anaesthetic agents, or both, which tend to slow the heart rate.
These effects peak at 24—28 weeks of gestation and are maintained until parturition when even greater alterations can be observed. Thus, patients with pre-existing cardiac disease are exposed to major cardiac stress in the second and third trimesters through delivery. Although pregnant patients with heart disease are usually managed with medical therapy, in some settings, those with severe decompensation and surgically correctable lesions might come to surgery, in particular those with severe mitral or aortic valvular obstruction.
Percutaneous balloon valvuloplasty seems to be a better alternative than surgical repair and is associated with a significant reduction in fetal and neonatal mortality. The use of cardiopulmonary bypass increases perioperative risk, particularly for the fetus. Factors related to cardiopulmonary bypass that can adversely affect fetal oxygenation include non-pulsatile perfusion, inadequate perfusion pressures, inadequate pump flow, embolic phenomena to the uteroplacental bed, and the release of renin and catecholamines.
Specifically, hypocapnia causes uteroplacental vasoconstriction, and hypercapnia increases uteroplacental blood flow but is associated with fetal acidosis and reduced cardiac function. During hypothermic cardiopulmonary bypass, acid—base disturbances can be more pronounced and there is no consensus regarding pH management during pregnancy.
Haemorrhage from intracranial saccular aneurysm or arteriovenous malformation is unfortunately not uncommon during pregnancy. The risk of intracranial haemorrhage is increased by hypertensive conditions of pregnancy and their associated risk factors.
The usual neurosurgical anaesthetic treatment of these patients can include controlled hypotension, hypothermia, hyperventilation, and diuresis, which must be undertaken carefully in the pregnant patient. Controlled hypotension can be induced with high-dose volatile anaesthetic, sodium nitroprusside, or nitroglycerin. Each carries its own potential hazards in addition to reduction in uteroplacental blood flow.
All of these drugs cross the placenta and can induce hypotension in the fetus. Nitroprusside is converted to cyanide and then to thiocyanate by the hepatic enzyme rhodanase.
Cyanide accumulation in the fetus has been observed with significant toxicity and fetal death in pregnant patients treated for long periods with sodium nitroprusside. If this agent is used: Inhalation agents isoflurane and sevoflurane provide the benefit of being both hypnotic and hypotensive agents at clinical concentrations where they reduce metabolic activity and potentially provide preconditioning. They are used alone or in combination with adjuvant agents to limit tachycardia and rebound hypertension.
Nitroglycerin has yet to be associated with adverse fetal effects and can be used as an adjuvant to reduce required doses of nitroprusside.
Nitroglycerin is metabolized to nitrites, which have produced methaemoglobinaemia experimentally. Induced hypotension is used less frequently when vascular clips are used proximal to the lesion, so this technique might be considered in the setting of pregnancy to avoid the need for induced maternal hypotension.
When induced hypotension is deemed necessary, fetal heart rate monitoring should be used and the period of hypotension.
Hypothermia is occasionally used in neurosurgical anaesthesia to decrease metabolic requirements in the brain and other organs and to reduce cerebral blood flow. Fetal heart rate will increase again with rewarming. Hyperventilation is commonly used in neuroanaesthesia to reduce and cerebral blood flow. As a result of increased ventilation during pregnancy, normal at steady state is 4—4. Fetal heart rate monitoring should alert the anaesthesiologist to compromises in fetal condition and adjustments to maternal ventilation should be made accordingly.
Diuresis is often accomplished with osmotic agents or loop diuretics to shrink the brain both intraoperatively and after operation. These can cause significant negative fluid shifts for the fetus. Mannitol given to a pregnant woman slowly accumulates in the fetus, and fetal hyperosmolality leads to physiological changes such as reduced fetal lung fluid production, reduced renal blood flow, and increased plasma sodium concentration.
However, in individual case reports, mannitol in small doses of 0. There are questions about fetal wellbeing during laparoscopic surgery. Direct fetal and uterine trauma and fetal acidosis from absorption of insufflated carbon dioxide are potential mechanisms of injury. With increased intra-abdominal pressure, maternal cardiac output and uteroplacental perfusion can decrease.
Animal data have supported these concerns. A comparison of laparotomy and laparoscopy performed in pregnancy in over 2 million pregnancies in Sweden over a 20 yr period found no difference in fetal outcome between the two techniques. Whenever possible, surgery should be deferred to the second trimester. Fetal and uterine status should be monitored and also end-tidal P co 2 and maternal arterial blood gases. An open technique should be used to enter the abdomen.
Aortocaval compression should be avoided. Oxford University Press is a department of the University of Oxford.
Considerations during pregnancy
Women who are better informed about the safety aspects of exercise during pregnancy will be more motivated to be physically active. Stress-induced pregnancy complications represent a significant cause of maternal and perinatal morbidity and mortality due to preterm labor, low-birth- weight. Pregnancy can change medication recommendations drastically.