Intraoperative Treatment of Fetal Asystole After Endovascular Repair of Aortic Coarctation in a Pregnant Woman with Mitral Stenosis

A G1P0 woman with aortic coarctation and mitral valve stenosis underwent endovascular aortic repair with continuous fetal monitoring during the 20th week of pregnancy. On tracheal extubation, an episode of fetal asystole followed by fetal bradycardia was identified. Ephedrine, nitroglycerin, and terbutaline were administered for intrauterine fetal resuscitation. Subsequently, the patient developed hypertension and pulmonary edema, which were treated with furosemide and noninvasive positive pressure ventilation. The fetal heart rate normalized. We conclude that intraoperative monitoring of a previable fetus may aid in optimizing maternal hemodynamics. Before performing interventional procedures in pregnant women, a multidisciplinary team should discuss the goals of neonatal care should adverse fetal events be detected.