Quick Reference: Pregnancy and CPB
- Use fetal monitoring and position patient with a 30-60 degree left lateral tilt to eliminate IVC compression.
- Blood volume of mom is 90-100 ml/kg.
- Pregnant patients are typically hypercoagulable. Check coagulation status frequently.
- Avoid femoral cannulation if possible. Bicaval cannulation is preferred.
- Use retrograde cardioplegia and scavenge the cardioplegia if possible.
- Maintain normothermia unless circ arrest is required (Temp > 32 C).
- Maintain HCT > 22%.
- Maintain MAP > 70 mmHg.
- Increase the FiO2 to maintain PO2 of 400.
- Flow at a CI of 2.8-3.2 (Flows should be 20-40% higher than flows used for non-pregnant patient).
- Fetal bradycardia is an indication to increase flow and pressure.
- Normal fetal heart rate is 120-160 beats/min.
- Safe range for on CPB is 110-120 beats/min.
Medication Cautions:
- Do not use Mannitol because it crosses the placenta. Use Lasix if diuresis is needed.
- Do not use Neosynephrine. Use Ephedrine or Dopamine to increase pressure.
- Do not use Sodium Nitroprusside. Use Hydralazine to decrease pressure.
