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Your Fetal Surgery
The Intraoperative Period
Recovery Period
Recovery Period
Medications for Preterm Labor (Tocolytics)
Pain Management
Antibiotics
Activity
Treatments
Diet
Discharge Preparation
The Intraoperative Period
The operating room (OR) nurse will escort you to the operating room. During the surgery, the anesthesiologist will monitor your heart and control your breathing through a tube in your throat and airway. He also may monitor your baby's heart rate during the surgery. The OR and scrub nurses manage and coordinate all aspects of the operative procedure. The perinatologist will assist in monitoring you and your baby during the operative procedure and will recommend medicines that prevent contractions and preterm labor, which are called tocolytics.
Recovery Period
After surgery you will be cared for on the obstetrical ward in the 15th floor Perinatal Service. When you awaken from the anesthesia you will notice a variety of tubes and medical devices used to monitor or treat you and your baby. They will include:
- A intravenous (IV) catheter
- A oxygen mask to provide extra oxygen after surgery when people don't breathe as deeply
- A fetal heart-rate monitor to check on the baby and show uterine response to tocolytics
- A foley catheter to collect urine from the bladder so it is not necessary to use the bathroom
- An epidural catheter in your back to deliver continuous pain medication
- A sequential compressive device (SCD) to help maintain circulation in your legs while on bed rest
A transparent dressing will cover your abdominal incision so that your baby can be monitored more easily and the site can be observed without removing the dressing.
The Postoperative Recovery Period
This period usually lasts four to seven days. You will continue to receive care on the Perinatal Unit of the UCSF Children's Hospital. The electronic fetal/uterine monitor will be worn continuously to assess your baby's heart rate and the possibility of preterm labor. Preterm labor is the most common complication of fetal surgery. Signs of preterm labor include:
- Abdominal tightening
- Cramping
- Backache
- Pelvic pressure
- Change in vaginal discharge
- Leakage of vaginal fluid
- Bleeding
- Gas pain
Medications for Preterm Labor (Tocolytics)
You may receive one or more of the following tocolytics to prevent uterine contractions (preterm labor).
Indocin Suppositories
Indocin helps stop production of prostaglandin, substances released from your uterus and cervix, which cause uterine activity. It is given by rectal suppository before and for up to 48 hours after surgery. The most common side effects are maternal stomach upset and a decrease in fetal amniotic fluid. These side effects will be monitored daily. An uncommon side effect includes the narrowing of a blood vessel in the fetal heart called the ductus. This is monitored by fetal echocardiography.
Magnesium Sulfate (MgSO4)
MgSO4 acts to relax body muscles. Since your uterus is a muscle, the frequency and strength of contractions is decreased by MgSO4. Your health care team will monitor you closely to determine your response to MgSO4. Since it is excreted in your urine, an accurate record of your fluid intake and urinary output will be kept. Daily weights will be obtained and blood levels will be drawn to insure that side effects are limited and not severe. The following are side effects of intravenous MgSO4:
- Flushing
- Sweating
- Muscle weakness (wet dishrag feeling)
- Nausea and vomiting
- Feeling sleepy and tired
- Blurred vision
- Fluid in the lungs (pulmonary edema)
After one to two days, you will be weaned from the MgSO4 and given another tocolytic taken orally in pill form, which will control uterine activity.
Nifedipine
Nifedipine relaxes your uterus. It can be given in pill form every 4 to 6 hours and is usually started while decreasing your Indocin dose. The following are potential side effects:
- Low blood pressure
- Flushing
- Rash
- Headache
Terbutaline
Terbutaline relaxes your uterus. It can be delivered at very low but effective doses in a pill form. The following are potential side effects:
- Increased heart rate, usually 90-110 beats per minute
- Increased sugar in the bloodstream
- Feeling shaky
- Nausea
- Constipation
- Feeling warm
- Headache
Some of these side effects subside as your body becomes used to terbutaline. Stool softeners may be prescribed as needed. You should notify your physician of a persistent headache. You will need to be tested for gestational diabetes to help us to know how well you will tolerate this drug.
Pain Management
A continuous infusion of morphine is the most commonly used method of pain management. This infusion is done through an epidural catheter that stays in you back for a few days. Often a numbing medicine called narcaine is added for improved pain relief. After the epidural catheter is removed you will receive oral pain medications. Possible side effects of morphine include:
- Itching
- Grogginess
- Slow breathing
- Nausea and vomiting
This medication will cross through the placenta and a very small amount will go to your baby. This will not harm your baby and may in fact help your baby be comfortable.
Antibiotics
Since infection is a possibility with any surgery, you will be given antibiotics through an IV for at least 48 hours, and you will be observed for signs and symptoms of infection. Please let your doctor know if you are allergic to any antibiotics.
Activity
You will be expected to remain in bed resting on your side. This position provides the best blood flow to you baby and your uterus and helps decrease uterine contractions. The urinary catheter will remain in place for about 48 to 72 hours. Bedpans must be used for bowel movements and urination until your catheter is removed. As your condition improves and uterine activity is controlled, you will be allowed to go to the bathroom and to shower. Depending on your condition, you will be able to get up to go to the bathroom by approximately the third postoperative day. By the fifth postoperative day you may walk to the nurses' station or down the hall once or twice a day. Again, this depends on your condition. Your perinatologist will determine your activity level during your recovery period.
Treatments
You will be expected to do a few things after surgery to prevent or treat lung and circulation complications from surgery and bed rest.
Incentive spirometer exercises -- a small, simple piece of equipment that helps you breathe in deeply and open your lungs as much as possible. This exercise should be repeated five times each hour that you are awake. Your nurse will instruct you on how to use this device.
Deep breathing -- a lung exercise that will help you keep all airways clear.
- Breathe in slowly allowing your abdomen to rise and your lungs to fill with air.
- Hold the air for about 5 seconds.
- Exhale slowly through your nose and mouth.
Turning -- should be done at least every two hours from side to side. You will be assisted as needed until you are able to accomplish this on you own. Benefits of movement and turning include:
- Increased circulation
- Promotion of deep breathing
- Decreased pressure areas on skin
Foot flexion exercises -- improve circulation and help prevent blood clots. Your nurse will instruct you on how to perform them.
Diet
No food or fluids will be allowed by mouth until digestive function returns. Your will still get fluids through your IV. Frequent mouth rinses, tooth brushing, and moist swabs are used to relieve dry mouth. Your doctor will advance your diet as tolerated. Once you have been able to pass gas rectally, fluid will be initiated. If you are able to tolerate fluids, you will start eating solid foods.
Discharge Preparation
Generally around the fourth to seventh day after surgery, you will be ready to leave the hospital if the following goals are met:
- Premature labor is controlled so that there are less than five contractions an hour and no cervical change
- You have walked the halls at least once without increasing uterine activity
- You have a good understanding of your medications and home care routines
Some fetal procedures make it necessary for you to stay in San Francisco until the time of delivery. You will be informed of this prior to undergoing the procedure.
The Fetal Treatment Center at UCSF Children's Hospital is a world leader in diagnosing and treating birth defects, using advanced therapies including fetal surgery.
More Information:
Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
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