Maternal and Fetal Monitoring

Imperative to fetal well-being during laparoscopy is tight control of maternal hemody-namic and respiratory function in order to maintain a normal maternal pH.

Controversy exists over the use of maternal PaCO2 versus EtCO2 for monitoring maternal acid/base status as a result of conflicting animal data regarding the effects on the fetus as mentioned above. Some have argued that the pregnant ewe model may not be appropriate for the study of the effects of the pneumoperitoneum on maternal aci-dosis and have demonstrated that capnography adequately reflects maternal acid/base status in humans (64). Furthermore, several large studies have observed that EtCO2 mea-surements may be used to monitor pregnant women undergoing laparoscopy safely and effectively without adverse fetal outcomes (12,13,55).

The fetus must also be monitored for signs of distress. One sign that may be easily detected is an increased fetal heart rate. While intraoperative fetal monitoring was once thought to be the most accurate method to detect fetal distress during laparoscopy, the literature to date in which intraoperative fetal monitoring was employed has not reported any abnormalities of fetal heart rate either during the procedure or postoperatively (50,65). This has led to the recommendation of preoperative and postoperative monitoring of the fetal heart rate, with no increased fetal morbidity having been reported (12,13).

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