Background and aim: Coexisting cardiovascular disease in pregnancy is associated with high maternal morbidity and mortality. These patients pose a great challenge to both anesthesiologist and obstetrician. Present study was aimed at reviewing the perioperative management and outcome of obstetrical surgeries in women who had coexisting cardiovascular disease in a tertiary care teaching institute. Materials and Methods: Departmental database of all pregnant patients with coexisting cardiovascular diseases who underwent obstetrical surgeries during January 2011 to August 2016 were reviewed. Patients functional status, obstetrical history, stage of labor, type of anaesthesia, monitoring, hemodynamics, post operative care and baby outcome were noted. Data are expressed in absolute number and percentage scale and INSTAT software was used for measuring central tendencies and dispersion. Results: A total of 22 women (mean + Standard deviation: SD age 26.18 + 4.78 years) were found eligible and included for analysis. 21(95.45%) patients underwent cesarean section and one medical termination of pregnancy. 68.18% cases were done under subarachnoid block. Most of the patient needed post operative high dependant unit care, one patient developed mild pulmonary edema and no maternal and fetal deaths were noted. All the babies were born with APGAR > 7 at 1 min. No patient was managed using pulmonary artery catheter or continuous cardiac output monitoring. Conclusion: Pregnant patients with coexisting cardiovascular disease need multidisciplinary approach, timely delivery and intensive therapy in perioperative period. They can be safely delivered under subarachnoid blocks. Pulmonary artery catheterization is probably not an essential for hemodynamics management of such patients in perioperative management.
Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl. 1):1–203.
Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010;116:1302-9.
Silverside CK, Colman JM. Physiological changes during pregnancy. In: Oakley C, Warnes CA, editors. Heart Disease in Pregnancy, 2nd edn. Oxford: Blackwell; 2007.pp. 6–17.
Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: a new classification. J R Soc Med 2000;93:346-50.
Feitosa HN, Moron AF, Born D, de Almeida PA. Maternal mortality due to heart disease. Rev Saude Publica 1991;25:443-51.
Hibbard LT. Maternal mortality due to cardiac disease. Clin Obstet Gynecol 1975;18:27–36.
Jindal UN, Dhall GI, Vasishta K, Dhall K, Wahi PL. The effect of maternal cardiac disease on perinatal outcome. Aus NZ J Obstet Gynecol 1988;28:113–5.
Centre for Disease Control and Prevention. Pregnancy Mortality Surveillance System. Atlanta, USA: U.S. Department of Health & Human Services; 21st Jan 2016. [Cited 2016 Sept 4]. Available from: http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html
Monagle J, Manikappa S, Ingram B, Malkoutzis V. Pulmonary hypertension and pregnancy: The experience of a tertiary institution over 15 years. Ann Card Anaesth 2015;18:153-60.
Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011;32:3147–97.
Thorne S, MacGregor A, Nelson-Piercy C. Risks of contraception and pregnancy in heart disease. Heart 2006;92:1520–5.
Karim HMR, Mitra JK, Bhattacharyya P, Roy J. Significance of hemodynamic monitoring in perioperative and critical care management in obstetric practice. Astrocyte 2015;1:295-300. doi: 10.4103/2349-0977.161623
Fujitani S, Baldisseri M R. Hemodynamic assessment in a pregnant and peripartum patient. Crit Care Med 2005; 33[Suppl]:S354–61.
Ghosh, S.B.L., Sabry, A. Anaesthetic considerations for patients with severe aortic stenosis. In: D.P. Santavy (editor) Aortic Valve Stenosis—Current View on Diagnostics and Treatment. InTech, Rijeka, Croatia; 2011:67–84.
Langesæter E, Gibbs M, Dyer RA. The role of cardiac output monitoring in obstetric anesthesia. Curr Opin Anaesthesiol 2015;28:247-53.
Shaikh SI, Lakshmi RR, Hegade G. Perioperative anesthetic management for cesarean section in patients with cardiac disease. Anesth Pain & Intensive Care 2014;18:377-85.
Burt CC, Durbridge J. Management of cardiac disease in pregnancy. Contin Educ Anaesth Crit Care Pain 2009;9:44 – 7.
Tamhane P, O’Sullivan G, Reynolds F. Oxytocin in parturients with cardiac disease. Int J Obstet Anesth 2006;15:332 – 3.
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