Placental transfer of drugs and perinatal pharmacology david c. Placental transfer of drugs and perinatal pharmacology. Boerhaave series for postgraduate medical education proceedings of the boerhaave courses organized by the faculty of medicine, university of leiden, the netherlands, vol 4. History the history of the caesarean section is unsure legend of emperor caesar. It includes ananatomical and physiological description of the maternal placental fetalunit with description of the placental. Recent intriguing reports implicate extracellular vesicles evs as carriers for the distribution of morphogens and growth and differentiation factors. Placental drug transfer an overview sciencedirect topics. The factors determining the placental transfer of drugs used in labour were studied in the rabbit placenta perfused in situ with krebs bicarbonate buffer. Anesthesia for cesarean section in the dog abstract the major goal in anesthesia for cesarean section cs is to minimize fetal effects of anesthetic drugs in order to minimize fetal respiratory, central nervous system and cardiovascular depression and deliver live, vigorous puppies. Drugs administered to mothers have the potential to cross the placenta and reach the fetus. Anaesthetic considerations for nonobstetric surgery during pregnancy e. Only the unbound portion free drug is available for placental transfer, and it therefore may take considerable time to reach distribution equilibrium between the maternal and fetal compartments. Anaesthetic considerations for nonobstetric surgery. Increases late because of decreased albumin possibly correct for some drugs but not the whole picture c.
Get a printable copy pdf file of the complete article 692k, or click on a page image below to browse page by page. All general anaesthetic drugs cross the placenta and there is no optimal general anaesthetic technique. Maternal plasma protein binding is a limiting factor for drugs that are transferred via placental membranes relatively slowly. Placental transfer of drugs the new york academy of. This study was designed to test whether there is any difference in the placental transfer of bupivacaine or lidocaine in the early compared to the late preterm maternalfetal sheep preparation.
A letter to the lancet in this year pointed out some errors in an editorial on the use of vasoconstrictor agents in localanaesthetic preparations 80. Physiology of ureteroplacental circulat authorstream. However, opinions about anaesthetic drug transfer via breastmilk are far from uniform. Campbell monica san vicente introduction walter channing, professor of obstetrics and dean of the school of medicine at harvard, described one of the first reports of the effects of anesthesia on the neonate in 1847. Anaesthetic management in humans, the improvements in epidural and spinal techniques are given credit for the current low mortality rates for both mothers and offspring dresner et al. Placental transfer from the maternal to the fetal side occurs primarily via passive diffusion, the physicochemical properties of drugs such as lipid solubility, polarity and molecular weight primarily determine the rate of transfer across the placenta.
Transplacental transfer of drugs used in pregnant women. If the foetus is compromised it may become acidotic. So the first step to examine potential fetotoxicity is to test transplacental transfer of drugs. Placental transfer and embryofetal effects of drugs used. In veterinary medicine there are insufficient data to state whether general or regional anaesthesia is safer.
The lack of association may be explained by the many factors other than maternal unbound ropivacaine that influence placental transfer of local anaesthetic agents. Anaesthetic considerations in caesarean section in bitch. The main objective of this book is to present the fundamentals and applications of drugs and equipment in anaesthetic practice to the undergraduate medical students. Placental drug transfer is dependent on the physical properties of the placental membrane and on the pharmacological properties of the drug.
The placental transfer of bupivacaine after paracervical block has been described above in the introductory paragraphs 77. Increases in late pregnancy probably the most correct option b. In the field of obstetric anaesthesia, the placental transfer of drugs is a shared and incontrovertible focus for both anaesthetic and neonatal clinicians. We suggested that the administration of dexmedetomidine during caesarean section under general anaesthesia would enhance the anaesthetic effects, reduce the anaesthetic dose and help stabilize the haemodynamics without adverse neonatal effects. Effect and placental transfer of dexmedetomidine during. During concurrent maternal intravenous infusion of bupivacaine, lignocaine, pethidine and antipyrine, drug concentrations were measured in maternal arterial plasma and placental effluent. The influence of anaesthetic drugs on the foetus and. The placental transfer and the foetal metabolism of dexmedetomidine have never been reported. Do not cross because 600 daltons no, but drugs with mw 500 have.
Stem cells are critical to maintaining steadystate organ homeostasis and regenerating injured tissues. Almost all anaesthetic drugs crossthe placenta easily, with the exception of the neuromuscular blocking agents. Muscle relaxants are highly ionized which impedes placental transfer, resulting in minimal effects on the fetus. Links to pubmed are also available for selected references. Data on the transfer of anaesthetic and analgesic drugs into. The positive impact of breastfeeding for both mothers and infants has been well established. Placental transfer of drugs administered to the mother. In this text, fm will be used as the equivalent of uvma or uama, as used, for example, in placental transfer of drugs and perinatal pharmacology in the most recent version of shnider and levinsons anesthesia for obstetrics. In this situation more of the foetal local anaesthetic will be ionised and hence unable to return to the maternal circulation. Under particular circumstances, the comparison of the drug concentration in the maternal and fetal plasma may give an idea of the exposure of the fetus to the maternally administered drugs. Placental transfer of local anaesthetics in the premature. However if the degree of abruption is minor, and there is no fetal or maternal compromise, the pregnancy may be allowed to. General anesthesia for obstetrics ulf lindsten md 2010.
This study shows that placental transfer of anaesthetic drugs can be studied during the. Local anesthetics are weakly basic drugs that are principally bound to 1acid glycoprotein. Content history indication preparation intraoperative management placental transfer of drugs drugs. 15 drugs and pregnancy 37 16 placental transfer of drugs 40 17 prescription and administration of drugs by midwives 42 18 local anaesthetics 44 19 normal labour 46 20 intrapartum fetal monitoring 51 21 pain of labour 54 22 epidural analgesia for labour 56 23 epidural test doses 61 24 combined spinalepidural analgesia and anaesthesia 64.
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