Peripartum considerations for women with cardiac disease

Hussey, Hanna; Hussey, Patrick; Meng, Marie-Louise

doi:10.1097/aco.0000000000000992

Cited by 7 publications

(4 citation statements)

References 44 publications

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“…Neuraxial anesthesia attenuates the increases in HR and contractility from endogenous catecholamines, pain, and anxiety. 9…”

Section: Discussionmentioning

confidence: 99%

“…Neuraxial anesthesia attenuates the increases in HR and contractility from endogenous catecholamines, pain, and anxiety. 9 Neuraxial anesthesia coverage for cerclage placement includes the S2-S4 nerve roots, which may be poorly cases-anesthesia-analgesia.org a & a pRaCtICe penetrated by epidural anesthesia without administration of large, concentrated volumes of local anesthetic in the epidural space as the larger nerve roots, covered by thicker dura matter, and are further away from a superiorly threaded epidural tip. 7,10 Epidural solution administration has been demonstrated to have more cephalad than caudal progression.…”

Section: Discussionmentioning

confidence: 99%

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A Case Report of Spinal Anesthesia for Cerclage Placement in the Setting of Severe Hypertrophic Obstructive Cardiomyopathy

Hussey

Egbaria

et al. 2023

A&A Practice

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Neuraxial anesthesia is preferred over general anesthesia in obstetric patients to avoid airway manipulation, aspiration, and maternal-fetal transfer of medications; however, a sudden sympathetic block is generally avoided in patients with hypertrophic obstructive cardiomyopathy (HOCM). The case of a 31-year-old G2P0010 with HOCM with severe resting left ventricular outflow tract (LVOT) obstruction and systolic anterior motion of the mitral valve undergoing a cerclage under choroprocaine spinal anesthesia is presented. Risks and benefits of general versus neuraxial anesthesia, and epidural versus spinal anesthesia, in this specific setting are reviewed.

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“…Neuraxial anesthesia attenuates the increases in HR and contractility from endogenous catecholamines, pain, and anxiety. 9…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case Report of Spinal Anesthesia for Cerclage Placement in the Setting of Severe Hypertrophic Obstructive Cardiomyopathy

Hussey

Egbaria

et al. 2023

A&A Practice

Self Cite

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“…Effective collaboration between healthcare professionals from different specialties is vital in caring for pregnant and postpartum women on ECMO. Obstetricians, neonatologists, cardiologists, and other relevant specialists should collaborate to formulate a comprehensive care plan that addresses maternal and fetal needs [34].…”

Section: Multidisciplinary Care and Collaborative Approachmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation (ECMO): A Lifeline for Pregnant and Postpartum Women

Dutta,

Hirani,

Heda

et al. 2023

Cureus

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Extracorporeal membrane oxygenation (ECMO) is a life-saving technology that temporarily supports the heart and lungs in critical care situations. This review article examines the role of ECMO as a lifeline for pregnant and postpartum women facing severe maternal and fetal conditions. The review begins with an overview of the physiology and pathophysiology of ECMO, including its procedure and how it supports cardiopulmonary function. Unique considerations specific to pregnant and postpartum women, such as physiological changes during pregnancy, risks and complications associated with ECMO, and the need to balance maternal and fetal considerations, are discussed. The indications for ECMO in this population are explored, including common maternal indications such as cardiogenic shock, acute respiratory distress syndrome (ARDS), pulmonary embolism, and eclampsia, as well as fetal indications such as fetal distress, hypoxic-ischemic encephalopathy (HIE), and twin-to-twin transfusion syndrome (TTTS). The challenges and considerations in ECMO for pregnant and postpartum women, including ethical considerations and the decision-making process, are highlighted. The review further explores the multidisciplinary care and collaborative approach required, emphasizing the importance of a specialized ECMO team and collaboration between obstetricians, neonatologists, cardiologists, and other specialists. Additionally, patient selection, pre-ECMO assessment, and planning strategies are discussed. The review evaluates existing literature and studies on ECMO in pregnant and postpartum women, analyzing survival rates and maternal and fetal outcomes and comparing different ECMO modalities and strategies. Future directions and research opportunities are presented, including emerging technologies, areas for further research and clinical trials, and improved patient selection and management strategies. The conclusion emphasizes the importance of ECMO as a lifeline for pregnant and postpartum women and the potential impact on maternal and fetal health. The review highlights the need for ongoing research and advancements in ECMO to optimize outcomes and improve care for this unique and vulnerable patient population.

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“…Women who have experienced PLMSCAD are often advised to consult with a multidisciplinary team of cardiologists and obstetricians before planning future pregnancies. The timing of subsequent pregnancies, the need for specialized monitoring, and potential interventions should be thoroughly discussed to ensure the best possible outcomes for both the mother and the fetus [ 35 ]. Furthermore, the long-term effects of PLMSCAD on maternal health, including the risk of cardiovascular events and the development of coronary artery disease, require continuous vigilance and appropriate risk management strategies.…”

Section: Reviewmentioning

confidence: 99%

Critical Insights Into the Management of Postpartum Left Main Spontaneous Coronary Artery Dissection: Current Strategies and Future Directions

Rathi,

Nagtode,

Chandra

et al. 2023

Cureus

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This review article delves into the multifaceted realm of postpartum left main spontaneous coronary artery dissection (PLMSCAD), an infrequent yet critical condition affecting women during the postpartum period. Through a comprehensive exploration of its pathophysiology, clinical presentation, diagnosis, management strategies, and future directions, this review provides a holistic understanding of PLMSCAD's complexities. The article highlights challenges in diagnosis due to overlapping symptoms and underscores the significance of prompt recognition and tailored interventions. Current management strategies, encompassing medical and interventional approaches, are analysed in the context of their short-term and long-term impact on patient outcomes. Ethical considerations and the role of patient education and support networks are explored, shedding light on the broader psychosocial dimensions of PLMSCAD management. As emerging research reveals insights into genetic influences, hormonal dynamics, and the prognosis of affected individuals, this review emphasises the necessity of collaborative research endeavours and data sharing to enhance our understanding and guide future strategies. Ultimately, this review underscores the urgency of addressing the unique needs of women experiencing PLMSCAD, urging ongoing research, multidisciplinary collaboration, and a patient-centred approach to optimise maternal health outcomes and well-being.

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Peripartum considerations for women with cardiac disease

Cited by 7 publications

References 44 publications

A Case Report of Spinal Anesthesia for Cerclage Placement in the Setting of Severe Hypertrophic Obstructive Cardiomyopathy

A Case Report of Spinal Anesthesia for Cerclage Placement in the Setting of Severe Hypertrophic Obstructive Cardiomyopathy

Extracorporeal Membrane Oxygenation (ECMO): A Lifeline for Pregnant and Postpartum Women

Critical Insights Into the Management of Postpartum Left Main Spontaneous Coronary Artery Dissection: Current Strategies and Future Directions

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