A 30-year-old female with no significant past medical history presented to our labor and delivery ward for induction of labor. Due to failure to progress, she was proceeded to cesarean delivery. Intraoperatively, it was noted that her uterus was hypotonic; she required supplemental methylergometrine to control the bleeding from the uterine atony. However, within three minutes of intramuscular (IM) administration, she complained of chest pain. She then subsequently developed pulmonary edema in the postoperative care unit, which required supplemental oxygen. She was found to have elevated troponin and brain natriuretic peptide (BNP), along with radiologic features of fluid overload suggestive of congestive cardiac failure, which all lead to the diagnosis of non-ST myocardial infarction. The patient had a normal computed tomography (CT) pulmonary angiogram, echocardiogram, and serial electrocardiograms (ECGs). She was successfully discharged from the hospital on postoperative day 4 with resolution of her symptoms and improving cardiac enzymes. Cardiology outpatient follow-up was arranged.
Anesthetic management of pregnant women can be challenging, with multiple factors affecting the decision-making process, especially when considering nonobstetric surgery. The well-being of the mother and the fetus are a priority; therefore, clear communication between the multidisciplinary team is crucial. Guidelines have been recommended by both the American College of Obstetricians and Gynecologists and American Society of Anesthesiologists for management in both elective and emergent scenarios. A thorough preoperative assessment is needed and can help mitigate the risks associated with anesthesia for both the mother and baby. Intraoperative management must consider the physiological changes, fetal gestational age, as well as concomitant surgical risks that occur with pregnancy. The recovery period postoperatively focuses on multimodal management as well as avoiding possible complications of surgery. With a comprehensive perioperative plan, the gestation can return to its natural course.
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