ABSTRACT
The concept of the fetus as a patient has become a standard of care and the ethical framework for maternal fetal intervention is now well developed. Depending upon the procedure and exposure, a fetal IV catheter is placed for infusion of fluids, blood, or medications, and intramuscular fetal anesthesia, and paralysis is provided with fentanyl and vecuronium. Fetal anesthesia is provided by the maternal inhalational anesthetic, and a narcotic dose and paralysis is delivered intramuscularly to the fetus. Similar to open maternal-fetal surgery, the patient is positioned supine, with left lateral tilt to maximize blood flow to the uterus and placenta as well as venous return. There have been no maternal deaths reported following open maternal-fetal surgery to date, but these procedures are associated with significant short-term morbidity. Subsequent pregnancies after open maternal-fetal surgery are at risk for uterine dehiscence and rupture if labor is allowed to occur, but fertility is not affected.
