Cardiopulmonary Bypass During Pregnancy

This is usually done for rheumatic mitral valve disease or endocarditis. Several caveats hold: 1) the procedure should be done after the first trimester but before the third trimester in order to avoid the period of organogenesis and the period where the cardiac demands and the blood volume are maximal; 2) keep the fetus adequately oxygenated and avoid acidosis; 3) keep the patient tilted slightly to the left to permit adequate venous return from the inferior vena cava as blood flow is 30-50% more in pregnancy; 4) the perfusion pressure should be kept at least 60 mmHg; 5) a fetal heart monitor should be in place; 6) the patient should not be cooled further than approximately 32-34°C to ensure that the fetus is not at risk of fibrillation due to low temperatures.

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