Nonobstetric surgery during pregnancy and perioperative fetal monitoring = Nonobstetric surgery during pregnancy and perioperative fetal monitoring

다국어 초록 (Multilingual Abstract)

we present here a 2 cases of nonobstetric surgery during pregnancy and intraoperative fetal monitoring. Case report: A 34-year-old Korean nullipara woman, with her 31 weeks 3days of normal pregnancy with no disease history, was referred to our outpatient clinic for recent frequent seizure and cognitive disorder. Solid tumor involving left thalamus and left lateral ventricle was detected on her brain MRI. She underwent small craniectomy with tumor biopsy and bilateral V-P shunt. Perioperatively, cardiotocography (CTG) was done to monitor fetal status. CTG showed a lack of beat-to-beat variability with normal fetal heart rate during the whole operation procedure. We observed the pattern and postoperative CTG showed recovery of variability. Pathological examination revealed a brain glioblastoma grade IV and at gestational age 32weeks and 4days cesarean section was done with necessity of maternal early radiation therapy. Although the premature baby had mild neonatal hyperbilirubinemia, her general status is tolerable till now. 2nd case, A 39-year-old Korean nullipara woman, with 30weeks pregnancy with no underlying disease, came to emergency center for severe low abdominal pain. Flat abdomen x-ray was suspicious of intestinal volvulus and emergency laparotomy was done. Post operative diagnosis was sigmoid colon volvulus and operation title was Hartman operation. During the operation, we checked fetal heart rate with ultrasound probe instead of CTG because it was abdominal operation. Postoperative recovery was uneventful and full term delivery was done with gestational age of 39weeks 3 days. The mother and baby were discharged with no complication. Conclusion:Sometimes there are clinical situations in which urgent surgery in pregnancy is necessary. Intraoperative fetal heart rate (FHR) monitoring of the infant during non-obstetric surgery is controversial and we must interprete intraoperative CTG correctly and not take a mistake of doing unnecessary cesarean section