Perioperative Medicine Web-Based Curriculum & Reference

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PERIOPERATIVE MEDICINE

Web-Based Curriculum & Reference

Editors

Kurt J. Pfeifer, MD, FACP

Steven L. Cohn, MD, FACP

Medical College of Wisconsin

State University of New York - Downstate

Pregnancy

Michael P. Carson, MD & David A. Halle, MD

	RISK MANAGEMENT
	Intraoperative Management

	MATERNAL CO2 MONITORING
	End-tidal or transcutaneous CO2 monitoring can be very useful for monitoring for intraoperative maternal complications in pregnant patients (see table at right). Intrapertioneal CO2 insufflation may increase maternal PaCO2. Although probably not severe, alterations in maternal PaCO2 levels can lead to uterine artery contraction.
	INTRAOPERATIVE MEDICATIONS
	TOCOLYTICS Beta-agonist tocolytics are associated with maternal pulmonary edema, atrial fibrillation, chest pain, and ECG changes. [11] Magnesium may decrease platelet aggregation. Ephedrine, if needed, is less likely to cause uterine artery spasm than other vasopressors.


INTRAOPERATIVE MATERNAL COMPLICATIONS DETECTED WITH CO2 MONITORING
Pneumothorax Hemorrhage
UTERINE CONTRACTIONS DO NOT EQUAL PRETERM LABOR
Tocolytics have significant side effects - do not treat uterine contractions unless truly concerning of preterm labor.