Introduction
Methods
Patient population
Statistical analysis
Ethics
Results
Patient population
Median maternal age (range) | 33 years (22–41) |
Median Gestational Age (range) | 13 weeks (7–34) |
Indication % (n) | |
Lumbar Disk Herniation | 66.7 (14) |
Cauda equina | 19 (4) |
Motor deficit | 33.3 (7) |
Acute pain | 14.3 (3) |
Trauma | 19 (4) |
Tumor | 9.5 (2) |
Schwannoma | 4.8 (1) |
Ependymoma | 4.8 (1) |
Infection | 4.8 (1) |
Perioperative and surgical management
Anesthesia % (n) | |
Balanced | 57.1 (12) |
TIVA | 42.9 (9) |
Median duration of surgery (range) | 90 min (41–240) |
Position | |
Prone | 71.4 (15) |
Decubitus position | 28.6 (6) |
Follow-up and peripartal complications
Selected cases
Discussion and recommendations
Surgical indication and perioperative risk assessment
Imaging procedures
General principles
MRI during pregnancy
Intraoperative fluoroscopy
Surgery, positioning and intraoperative fetal monitoring
Analgesics and antibiotics management
Anesthesia
Conclusion
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Perform native MRI without contrast enhancement for diagnostics
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Reduce fluoroscopic control during surgery if possible
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Maintain sufficient uteroplacental perfusion (prevent hypotension, mean arterial blood pressure at or above 70 mmHg)
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Avoid aortocaval compression through adequate positioning (prone for first, lateral for second and third trimester)
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Select drugs with sufficient safety data (although no anesthetic has been identified as teratogen)
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If possible, use regional anesthesia (rare in spinal disorders)
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Use CTG/ultrasound device monitoring for perioperative monitoring (after 24 weeks of gestation).
< 12 weeks | 12–24 weeks | > 24 weeks | |
---|---|---|---|
Diagnostics | MRI | MRI | MRI |
Positioning | Prone | Left lateral | Left lateral |
Monitoring | Ultrasound | Ultrasound | CTG ± Ultrasound |
MAP Anesthesia | > 70 mmHg | > 70 mmHg | > 70 mmHg |
Analgetics | Paracetamol, ibuprofen, diclofenac | Paracetamol, ibuprofen, diclofenac | Paracetamol, opioids |