Maternal pulmonary edema during fetoscopic surgery.

Robinson, Marnie B; Crombleholme, Timothy M; Kurth, Charles D

Minimally invasive fetal surgery uses small endoscopes placed percutaneously through the mother's abdominal wall in order to operate on a fetus, placenta or umbilical cord. We report a case of postoperative pulmonary edema in a mother who underwent minimally invasive fetal surgery for the treatment of twin reverse arterial perfusion sequence. The procedure involves ultrasound and fetoscopic guidance to interrupt umbilical vessel blood flow to one twin. Saline irrigation is used during the procedure to facilitate surgical exposure. We hypothesize that the pulmonary edema resulted from irrigating fluid (totaling net 8 L) absorbed i.v. through myometrial venous channels accessed by passage of the operating trocars.