ABSTRACT
Fetal movement during intra-uterine fetal therapy makes these procedures technically more difficult and increases the likelihood of trauma to the fetus. Pancuronium or pipecuronium were used in a randomised study to temporarily arrest movement in 16 fetuses undergoing intra-uterine procedures. Under ultrasound guidance, pancuronium or pipecuronium 0.2 mg.kg-1 was injected into the fetal gluteal region. Fetal movements ceased within 4.6 +/- 2.3 min in the pancuronium group and 4.5 +/- 2.8 min in the pipecuronium group and returned by 115 +/- 26 min in the pancuronium group and 121 +/- 32 min in the pipecuronium group. No adverse effects of the relaxant were observed in the mothers. There was no evidence of soft tissue, nerve or muscle damage at the fetal injection site after delivery. Both muscle relaxants provided a safer method for diagnostic and therapeutic procedures. However, four cases in the pancuronium group (50%) developed a fetal tachycardia, and two cases in the same group showed loss of beat-to-beat variability. Pipecuronium appeared to be more suitable for intra-uterine procedures.
Subject(s)
Fetal Diseases/therapy , Fetal Movement/drug effects , Pancuronium/administration & dosage , Pipecuronium/administration & dosage , Female , Heart Rate, Fetal/drug effects , Humans , Nerve Block , Neuromuscular Junction/drug effects , Pregnancy , Time FactorsABSTRACT
Antenatal intrauterine fetal therapy has now become the target of numerous invasive diagnostic and therapeutic maneuvers. Fetal motion during intrauterine fetal therapy not only makes these procedures technically more difficult but also increases the likelihood of trauma to the umbilical vessels and the fetus. Combination of high doses of sedatives, tranquilizers, and narcotics rarely results in adequate suppression of fetal movement. Such medication puts the mother at risk of respiratory depression, regurgitation and aspiration. The use of pancuronium or atracurium to temporarily arrest fetal movement in ten fetus is reported. After an initial ultrasound assessment of fetal lie, placental location, and umbilical cord insertion site, the fetal weight was calculated by the ultrasound parameters of biparietal diameter and abdominal circumference. Under ultrasound guidance, we injected pancuronium 0.15 mg/kg or atracurium 1.0 mg/kg using a 23-gauge spinal needle into the fetal gluteal muscle. Short-term paralysis of the fetus was induced in all cases. Fetal movement stopped by sonographic observation within 5.8 +/- 2.3 min in the pancuronium group and 4.7 +/- 1.8 min in the atracurium group. Fetal movements returned both to maternal sensation or ultrasonic observation by 92 +/- 23 min in the first group and 36 +/- 11 min in the second group. No adverse effect of the relaxant has been observed in any of the mothers. There was no evidence of local soft tissue, nerve or muscle damage at the site of injection on initial examination of the neonates after delivery. The use of neuromuscular relaxant in fetus was a safe and useful method.