Introduction: Pregnancy after bariatric surgery is a high-risk pregnancy. Post-bariatric complications may require emergency surgical intervention. During laparoscopic surgery, anesthetic drugs and formation of pneumoperitoneum influence maternal hemodynamics and may impair the perfusion of the utero-placental unit. Subsequent changes of the fetal heart rate (FHR) might be recognized with intra-operative fetal monitoring and guide maternal positioning and hemodynamic management to maintain fetal wellbeing. However, current fetal monitoring guidelines do not include FHR interpretation during general anesthesia. Furthermore, FHR registration using conventional cardiotocogram (CTG) may be technically difficult due to surgically induced pneumoperitoneum. We developed a multidisciplinary local standard operating procedure based on current literature and guidelines. Intra-operative fetal monitoring using conventional CTG was implemented during laparoscopic surgery for suspected complication after bariatric surgery. We aim to establish whether FHR monitoring during laparoscopy is technically feasible. Secondary, we aim to establish a guideline for interpretation of intra-operative FHR during surgery.
Methods and analysis: Prospective, observational, feasibility study in a tertiary care hospital with a national referral function for post-bariatric complications in pregnancy. We will collect data from pregnant women with a gestational age of ≥ 24 weeks with a suspicion of a complication after bariatric surgery requiring surgical exploration. Non-Dutch speaking women and women with multiple gestation will be excluded. Data will be collected in Research Manager and analyzed using IBM SPSS Statistics for Windows, version 22.
Discussion: The available literature on intra-operative fetal monitoring is scarce. However, despite ambiguity in current international guidelines FHR monitoring is performed in various clinics. To avoid unnecessary caesareans during surgery it is important that FHR monitoring is of sufficient registration quality and that there are guidelines for interpretation of CTG during general anesthesia. However, the technique of intra-operative CTG has not been validated and hence the relevance of our standard operating procedure on intra-operative fetal monitoring during surgery for complications after bariatric surgery.
Keywords: Fetal monitoring; intra-operative fetal monitoring; non-obstetric surgery; pregnancy after bariatric surgery; standard operating procedure.