Recognition and management of maternal cardiac disease in pregnancy

Ray, Pradeep; Murphy, GJ; Shutt, L.E.

doi:10.1093/bja/aeh194

Cited by 123 publications

(123 citation statements)

References 97 publications

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“…Effective labor analgesia decreases sympathetic outflow and decreases plasma catecholamine levels. 22 Multiple modes of anaesthesia have been described in the literature for operative delivery of patients with PPCM. The hemodynamic goals of anaesthesia, however, are common to all approaches.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of a Patient with Peripartum Cardiomyopathy: A Case Report

Saha¹,

Islam

Ahmed

et al. 2016

Birdem Med J

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Peripartum cardiomyopathy is a rare affliction of healthy, young, females characterized by congestive heart failure, intracardiac thrombus, and frequently death. PPCM is associated with a hypercoagulative state, which can cause thromboembolic complications, may be, the initial demonstration off peripartum cardiomyopathy, which is usually an intracardiac thrombosis. Lower extremity embolism is uncommon. We present a case of 22 yr old female a known case of preeclamtic toxaemia associated with bronchial asthma underwent caesarian section at 36 wks of pregnancy & developed severe respiratory distress and needed mechanical ventilation. Two weeks after delivery she developed low back pain with parasthesia of both lower limbs associated with shortness of breath & diagnosed as a case of infra-renal aortic thrombus extending down to common illiac arteries associated with postpartum dilated cardiomyopathy and admitted at our hospital for embolectomy. Infiltration anaesthesia and conscious sedation with invasive monitoring was planned. Surgery and anaesthesia proceeded uneventfully.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of a Patient with Peripartum Cardiomyopathy: A Case Report

Saha¹,

Islam

Ahmed

et al. 2016

Birdem Med J

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“…The surgical approach is preferred as it allows the procedure to be performed in a more scheduled manner to obtain the best outcome. Surgical termination has a relatively short duration and reduced risk of failure, and the anesthetic risk can be minimized using a general anesthesia [14]. Oxytocics can be used cautiously, and endocarditis prophylaxis though is not recommended is advised in the Indian scenario.…”

Section: Management Planmentioning

confidence: 99%

Pregnancy After Cardiac Surgery

Kanhere

2016

J Obstet Gynecol India

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Heart disease is one of the common, indirect obstetric causes of maternal death. Management of these cases may challenge the entire team providing care to the mother and fetus. Advances in cardiac surgery has improved quality of life and level of functioning of cardiovascular system of patients with congenital or acquired heart disease. These diseases complicate 0.1-4 % pregnancies. Maternal complications in the form of thromboembolic, hemorrhagic episode and heart failure may occur. The fetus is in danger of effects of oral anticoagulation therapy and other medications given to the patient in order to support cardiovascular system, intrauterine growth restriction and danger of hypoxia. In recent era, we are facing more pregnant patients with previous history of surgical correction of congenital or rheumatic heart disease. 123In this review, we have attempted to draw a management protocol of such patients based on the available literature and various international guidelines. In pregnant women with mechanical heart valves, recent data support warfarin use throughout pregnancy, followed by a switch to heparin and planned induction of labor. However, the complexity of this situation demands a cafeteria approach where the patient herself can choose from the available options that are supported by evidence-based information. Preconception counseling, evaluation and antenatal high-risk management protocol with the help of cardiologist and cardiac surgeon improves maternal and neonatal outcome.

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“…In pregnant women, aortic dissection, poses serious risk for the mother and the foetus and the mortality rates for both the mother and the foetus are high. The ultimate goal is to ensure the safety of the mother and the foetus (6).…”

Section: Introductionmentioning

confidence: 99%

Anaesthesia for Caesarean Delivery in a Pregnant with Acute Type B Aortic Dissection

Kayhan¹,

Gülhaş²,

Şahin³

et al. 2013

Turk J Anesth Reanim

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Case Report 178About 50% of aortic dissections in women younger than 40 years occur during pregnancy; mostly in the 3rd trimesters and postpartum period. Aortic dissection in pregnancy creates a serious mortality risk for both mother and the foetus. The ultimate goal is to ensure the safety of both the mother and the foetus. In such cases, the best method of anaesthesia for caesarean delivery is still controversial. The first aim of anaesthetic management is to reduce the effect of cardiovascular instability on the dissected aorta. Here, we report the anaesthetic management of a 36 year-old pregnant woman who developed acute type B aortic dissection in the 30 th gestational weeks and scheduled for caesarean section. Since hemodynamic stability could not be achieved despite nitro-glycerine and esmolol infusions, together with invasive arterial monitoring, the decision for caesarean delivery was taken. A team of Cardiovascular Surgeons and an operating room were prepared because of the risks of aortic rupture and hemodynamic collapse during operation. Combined-spinal epidural anaesthesia was administered using 5 mg hyperbaric bupivacaine and 20 μg fentanyl given at the L3-4 spinal level in the side lying position. After achieving T4 sensory block level, the operation proceeded and a baby weighing 1432 grams was delivered in 4 min with a median subumbilical incision. Epidural patient controlled analgesia was applied to the patient during follow-up with medical treatment at postoperative period. In pregnant women with acute Type B aortic dissection, if adequate sensory block level cannot be achieved despite using a combination of low dose local anaesthetic (spinal use) and opioids, we are in the opinion that combined spinal-epidural anaesthesia, which allows the use of additional doses can be a decent choice.

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Recognition and management of maternal cardiac disease in pregnancy

Cited by 123 publications

References 97 publications

Anaesthetic Management of a Patient with Peripartum Cardiomyopathy: A Case Report

Anaesthetic Management of a Patient with Peripartum Cardiomyopathy: A Case Report

Pregnancy After Cardiac Surgery

Anaesthesia for Caesarean Delivery in a Pregnant with Acute Type B Aortic Dissection

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