Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 17 , ISSUE 4 ( October-December, 2023 ) > List of Articles


Obstetric Anesthesiology as the Third Pillar of Perinatology

Petronella Hupuczi, Zoltán Papp

Keywords : Anesthesiology, Definition of perinatology, Hemolysis, elevated liver enzymes, low platelet count syndrome, Intensive therapy, Neonatology, Obstetrics, Peripartum hemorrhage, Preeclampsia

Citation Information : Hupuczi P, Papp Z. Obstetric Anesthesiology as the Third Pillar of Perinatology. Donald School J Ultrasound Obstet Gynecol 2023; 17 (4):317-322.

DOI: 10.5005/jp-journals-10009-1993

License: CC BY-NC 4.0

Published Online: 28-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Perinatology emerged in the second half of the 20th century when the examination, care, and treatment of the fetus as a patient became possible before and during birth with various biochemical and biophysical methods. The life functions of preterm newborn infants could be maintained with intensive care therapy. Nowadays, the health and the life of pregnant and puerperal women as well as their fetuses/neonates can dominantly be supported by professionals in obstetrics, neonatology, and anesthesiology. Perinatology combines collaborative efforts from obstetrics, neonatology, and anesthesiology, along with intensive therapy for caring about the life and health of the mother and the fetal/neonatal patients. In this volume, the third pillar of the triangle of perinatal care is emphasized. Participation of obstetrical anesthesiologists in the process of indication, mode of anesthesia, and timing of operative delivery is essential. Preeclampsia/eclampsia/hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, and serious peripartum bleeding are the most common maternal and fetal life-threatening conditions, which require a high level of adult intensive care. The objective of this review is to prove the role of anesthesiology and intensive therapy as the third pillar of perinatal medicine in the management of great obstetrical syndromes.

  1. Kurjak A. First 10 years of the International Academy of Perinatal Medicine – which lessons we have learned and what are future challenges. J Perinat Med 2016;44(7):733–735. DOI: 10.1515/jpm-2016-0018
  2. Saling E. Neues Vorgehen zur Untersuchung des Kindes unter der Geburt (Einführung, Technik, Grundlagen). Arch Gynäkol 1962;197:108–122. DOI: 10.1007/BF02590014
  3. Caldeyro-Barcia R. Mechanisms and significance of the variations registered in the heart rate of the human fetus during labor. Tokoginecol Pract 1964;23:387–433.
  4. Donald I, MacVicar J, Brown TG. Investigation of abdominal masses by pulsed ultrasound. Lancet 1958;1(7032):1188–1195. DOI: 10.1016/s0140-6736(58)91905-6
  5. Schaffer AJ. Diseases of the Newborn. WG Saunders; 1960.
  6. Smith CA. Physiology of the Newborn Infant. CC Thomas; 1945.
  7. Iffy L, Kaminetzky HA. Principles and Practice of Obstetrics and Perinatology I–II. New York: John Wiley & Sons, Inc.; 1981.
  8. Skupski DW, Chervenak FA, McCullough LB, et al. Ethical dimensions of periviability. J Perinat Med 2010;38(6):579–583. DOI: 10.1515/jpm.2010.098
  9. McCullough LB, Coverdale JH, Chervenak FA. Professional integrity in maternal–fetal innovation and research: an essential component of perinatal medicine. J Perinat Med 2021;49(9):1027–1032. DOI: 10.1515/jpm-2021-0090
  10. Papp Z. Hot topics in perinatal medicine. J Perinat Med 2015;43:637–639. DOI: 10.1515/jpm-2015-0247
  11. Nagy S, Papp Z. Global approach of the cesarean section rates. J Perinat Med 2020;49(1):1–4. DOI: 10.1515/jpm-2020-0463
  12. Romero R, Jung E, Chaiworapongsa T, et al. Toward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology. Am J Obstet Gynecol 2022;227(4):615.e1–615.e25. DOI: 10.1016/j.ajog.2022.04.015
  13. Filetici N, Van de Velde M, Roofthooft E, et al. Maternal sepsis. Best Pract Res Clin Anaesthesiol 2022;36(1):165–177. DOI: 10.1016/j.bpa.2022.03.003
  14. Hupuczi P, Papp Z. Postoperative ascites associated with intraperitoneal antiseptic lavage. Obstet Gynecol 2005;105(5 Pt 2):1267–1268. DOI: 10.1097/
  15. Gávai M, Hupuczi P, Berkes E, et al. Spinal anesthesia for cesarean section in a woman with Kartagener's syndrome and a twin pregnancy. Int J Obstet Anesth 2007;16(3):284–287. DOI: 10.1016/j.ijoa.2006.11.014
  16. Chang KJ, Seow KM, Chen KH. Preeclampsia: recent advances in predicting, preventing, and managing the maternal and fetal life-threatening condition. Int J Environ Res Public Health 2023;20(4):2994. DOI: 10.3390/ijerph20042994
  17. Nagy B, Berkes E, Rigó B, et al. Under-expression of CD24 in pre-eclamptic placental tissues determined by quantitative real-time RT-PCR. Fetal Diagn Ther 2008;23(4):263–266. DOI: 10.1159/000123612
  18. Than NG, Vaisbuch E, Kim CJ, et al. Handbook of Growth and Growth Monitoring in Health and Disease. New York: Springer; 2012. pp 1867–1891.
  19. Szabó S, Mody M, Romero R, et al. Activation of villous trophoblastic p38 and ERK1/2 signaling pathways in preterm preeclampsia and HELLP syndrome. Pathol Oncol Res 2015;21(3):659–668. DOI: 10.1007/s12253-014-9872-9
  20. Szabó S, Karászi K, Romero R, et al. Proteomic identification of Placental Protein 1 (PP1), PP8, and PP22 and characterization of their placental expression in healthy pregnancies and in preeclampsia. Placenta 2020;99:197–207. DOI: 10.1016/j.placenta.2020.05.013
  21. Oravecz O, Balogh A, Romero R, et al. Proteoglycans: systems-level insight into their expression in healthy and diseased placentas. Int J Mol Sci 2022;23(10):5798. DOI: 10.3390/ijms23105798
  22. Nagy B, Hupuczi P, Papp Z. High frequency of methylenetetrahydrofolate reductase 677TT genotype in Hungarian HELLP syndrome patients determined by quantitative real-time PCR. J Hum Hypertens 2007;21(2): 154–158. DOI: 10.1038/sj.jhh.1002122
  23. Sziller I, Babula O, Hupuczi P, et al. Mannose-binding lectin (MBL) codon 54 gene polymorphism protects against development of pre-eclampsia, HELLP syndrome and pre-eclampsia-associated intrauterine growth restriction. Mol Hum Reprod 2007;13(4):281–285. DOI: 10.1093/molehr/gam003
  24. Than NG, Abdul Rahman O, Magenheim R, et al. Placental protein 13 (galectin-13) has decreased placental expression but increased shedding and maternal serum concentrations in patients presenting with preterm pre-eclampsia and HELLP syndrome. Virchows Arch 2008;453(4):387–400. DOI: 10.1007/s00428-008-0658-x
  25. Várkonyi T, Nagy B, Füle T, et al. Microarray profiling reveals that placental transcriptomes of early-onset HELLP syndrome and preeclampsia are similar. Placenta 2011;32:S21–S29. DOI: 10.1016/j.placenta.2010.04.014
  26. Hupuczi P, Nagy B, Sziller I, et al. Characteristic laboratory changes in pregnancies complicated by HELLP syndrome. Hypertens Pregnancy 2007;26(4):389–401. DOI: 10.1080/10641950701521221
  27. Hupuczi P, Rigó B, Sziller I, et al. Follow-up analysis of pregnancies complicated by HELLP syndrome. Fetal Diagn Ther 2006;21(6):519–522. DOI: 10.1159/000095665
  28. Salam RA, Mansoor T, Mallick D, et al. Essential childbirth and postnatal interventions for improved maternal and neonatal health. Reprod Health 2014;11(Suppl 1):S3. DOI: 10.1186/1742-4755-11-S1-S3
  29. Stefanovic V. International Academy of Perinatal Medicine (IAPM) guidelines for screening, prediction, prevention and management of pre-eclampsia to reduce maternal mortality in developing countries. J Perinat Med 2021;51(2):164–169. DOI: 10.1515/jpm-2021-0636
  30. Scavone BM, Wong CA. Neuraxial anesthesia and the ubiquitous platelet count question-how low is too low? Anesth Analg 2021;132(6):1527–1530. DOI: 10.1213/ANE.0000000000005496
  31. Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia 2015;70(11):1286–1306. DOI: 10.1111/anae.13260
  32. Post SE, Rood KM, Kiefer MK. Interventions of postpartum hemorrhage. Clin Obstet Gynecol 2023;66(2):367–383. DOI: 10.1097/GRF.0000000000000785
  33. van den Akker T, Brobbel C, Dekkers OM, et al. Prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy worldwide: a systematic review and meta-analysis. Obstet Gynecol 2016;128(6):1281–1294. DOI: 10.1097/AOG.0000000000001736
  34. Papp Z, Tóth-Pál E, Papp C, et al. Hypogastric artery ligation for intractable pelvic hemorrhage. Int J Gynecol Obstet 2006;92(1):27–31. DOI: 10.1016/j.ijgo.2005.08.022
  35. Sziller I, Hupuczi P, Papp Z. Hypogastric artery ligation for severe hemorrhage in obstetric patients. J Perinat Med 2007;35(3):187–192. DOI: 10.1515/JPM.2007.049
  36. Papp Z, Sziller I, Hupuczi P. Current Progress in Obstetrics & Gynaecology. Mumbai: TreeLife Media; 2012. pp. 198–214.
  37. Dhariwal NK, Lynde GC. Update in the management of patients with preeclampsia. Anesthesiol Clin 2017;35(1): 95–106. DOI: 10.1016/j.anclin.2016.09.009
  38. Russell R. Preeclampsia and the anaesthesiologist: current management. Curr Opin Anaesthesiol 2020;33:305–310. DOI: 10.1097/ACO.0000000000000835
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