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OBSTETRIC ANESTHESIOLOGY

Maternal Pulmonary Edema During Fetoscopic Surgery

Marnie B. Robinson, MD^*, Timothy M. Crombleholme, MD, and Charles D. Kurth, MD

From the *Departments of Anesthesiology and Surgery, The Fetal Care Center of Cincinnati, and Divisions of Anesthesia, and Pediatric, Thoracic, and Fetal Surgery, Cincinnati Children’s Hospital and Medical Center, Cincinnati, Ohio.

Address correspondence and reprint requests to Charles D. Kurth, MD, 3333 Burnet Ave., ML-2001, Cincinnati, OH 45229. Address e-mail to dean.kurth{at}cchmc.org.

Abstract

Minimally invasive fetal surgery uses small endoscopes placed percutaneously through the mother’s abdominal wall in order to operate on a fetus, placenta or umbilical cord. We report a case of postoperative pulmonary edema in a mother who underwent minimally invasive fetal surgery for the treatment of twin reverse arterial perfusion sequence. The procedure involves ultrasound and fetoscopic guidance to interrupt umbilical vessel blood flow to one twin. Saline irrigation is used during the procedure to facilitate surgical exposure. We hypothesize that the pulmonary edema resulted from irrigating fluid (totaling net 8 L) absorbed IV through myometrial venous channels accessed by passage of the operating trocars.