Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK.
Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.
Sci Rep. 2020 Jul 2;10(1):10867. doi: 10.1038/s41598-020-67714-y.
A cohort study of 6,500,000 human pregnancies showed an increased risk of adverse fetal outcomes following abdominal but not non-abdominal surgery under general anesthesia. This may be the consequence of uterine handling during abdominal surgery. However, there are no data on any effects on the cardiometabolic physiology of the fetus or mother in response to uterine manipulation in otherwise healthy pregnancy. Consequently, 9 sheep in late gestation were anesthetized with isofluorane and maternal and fetal catheters and flow probes were implanted to determine cardiovascular and metabolic changes during uterine handling. Uterine handling led to an acute increase in uterine artery vascular resistance, fetal peripheral vasoconstriction, a reduction in oxygen delivery to the femoral circulation, worsening fetal acidosis. There was no evidence of systemic fetal hypoxia, or changes in fetal heart rate, carotid blood flow or carotid oxygen delivery. Therefore, the data support that uterine handling during abdominal surgery under general anesthesia can impact adversely on fetal cardiometabolic health. This may provide a potential explanation linking adverse fetal outcomes in abdominal compared with non-abdominal surgery during pregnancy. The data have important implications for human fetal surgery where the uterus is handled, as operative procedures during late gestation under general maternal anesthesia become more prevalent.
一项涉及 650 万例妊娠的队列研究表明，全身麻醉下腹部手术而非非腹部手术会增加不良胎儿结局的风险。这可能是腹部手术中子宫操作的结果。然而，对于在其他方面健康的妊娠中子宫操作对胎儿或母亲的心脏代谢生理学的任何影响，尚无数据。因此，在妊娠晚期对 9 只绵羊进行异氟烷麻醉，并植入母体和胎儿导管和流量探头，以确定子宫操作过程中的心血管和代谢变化。子宫操作导致子宫动脉血管阻力急性增加，胎儿外周血管收缩，股骨循环的氧输送减少，胎儿酸中毒加重。没有证据表明胎儿全身缺氧，或胎儿心率、颈动脉血流量或颈动脉氧输送发生变化。因此，这些数据支持全身麻醉下腹部手术中的子宫操作会对胎儿心脏代谢健康产生不利影响。这可能为在妊娠期间与腹部手术相比非腹部手术中出现不良胎儿结局提供了一个潜在的解释。这些数据对于子宫操作的人类胎儿手术具有重要意义，因为在妊娠晚期全身麻醉下进行的手术操作变得越来越普遍。
