Neurosurgery in an Obstetric Patient -- Reconciling Competing Clinical Goals

Kulshrestha, Mayank; Khan, Nagina Naz; Kapadia, Mustafa; Saxena, Dipti
May 2014
Indian Anaesthetists' Forum;May2014, Vol. 15 Issue 5, p1
Academic Journal
A 26 year-old primigravida at 30 weeks of pregnancy presented with frequent seizures, headache and vomiting. On examination she had a right sided hemiparesis. Magnetic Resonance Imaging (MRI) findings were suggestive of infective aetiology with possibility of tuberculoma. Emergency surgery was decided in view of rapid deterioration in patient's neurological state and uncontrollable headache and vomiting. Anaesthetic management was tailored for both pregnancy and an intracranial space occupying lesion. Foetal heart rate (FHR) was monitored prior to operation and throughout the surgery and periodically for 24 hours postoperatively. An obstetrician was requested to remain as standby for FHR assessment and for an urgent caesarean section if required in case of foetal distress. The major concerns for the anaesthesiologist are maternal and foetal monitoring and utero-placental drug transfer.


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