Use of Doppler ultrasound in the management of uteroplacental perfusion during cardiopulmonary bypass in pregnancy

• During cardiac surgery the fetus requires continuous assessment.
• In our case fetal Doppler ultrasound was used during cardiopulmonary bypass.
• Fetal monitoring resulted in changes to anesthetic management minimizing fetal risk.
• Multidisciplinary planning and communication led to a successful outcome.

Cardiopulmonary bypass, the extreme of non-obstetric surgery during pregnancy, presents unique challenges to minimize maternal and fetal risk. We present our experience with a woman who was diagnosed with a left atrial myxoma following an ischemic cerebrovascular accident. We discuss clinical management specific to cardiopulmonary bypass during pregnancy and delivery in the context of a multidisciplinary team approach. We recommend using intermittent Doppler ultrasound as a non-invasive real-time assessment of uteroplacental perfusion during non-obstetric surgery in pregnancy. Monitoring of perfusion facilitates active feedback for appropriate in utero resuscitation in these cases.