Abstract
This is a case report of a full term pregnant patient with severe mitral stenosis and impending cardiac failure. We provided labour analgesia to this patient with epidural local anaesthetics and opioids and conducted the delivery of baby safely.We recommend the use of labour analgesia to attenuate the response of pregnency and labour on cardiovascular system in mitral stenosis patient.Key Messages: Epidural labour analgesia is safe and effective in severe mitral stenosis and it blunts the hemodynamic response of labour and pregnancy.
Highlights
In traditional teaching, severe mitral stenosis (MS) is considered to be a relative contraindication to neuraxial blockade as sympathetectomy associated with neuraxial blockade can cause hypotension and compensatory tachycardia which are poorly tolerated in severe MS
MS usua lly presents with dyspnoea on exertion, palpitations, pedal oedema and rarely chest pain
Epidural analgesia is shown to decrease the increase in cardiac output during labour and in immediate postpartum period.[1]
Summary
Severe mitral stenosis (MS) is considered to be a relative contraindication to neuraxial blockade as sympathetectomy associated with neuraxial blockade can cause hypotension and compensatory tachycardia which are poorly tolerated in severe MS. Patient was diagnosed to be suffering from rheumatic heart disease at 2 months of pregnancy when she consulted cardiologist for progressively incr easing dyspnoea on exertion. Patient ha d complains of dyspnoea and chest pain with each uterine contraction. We used 0.0625% bupivacaine with 5 μg/ml fentanyl in epidural.
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