Abstract
Pregnant patients with Congenital heart disease (CHD) make for a unique challenge to the obstetrician and anesthesiologist, when the patient has to undergo emergency cesarean section. Managing high-risk parturient requires a thorough understanding of the hemodynamic changes of pregnancy, its effect on the patient and physiology of the abnormal heart. Beyond this, our patient presented with placenta previa and vaginal bleeding. This combination of factors makes this case a worst-case scenario for any anesthesiologist. There is limited data in the literature on these combination factors. CHD is becoming the most common source of cardiac problems in pregnant patients but non-corrected cardiac defect patient are rare cases in the obstetric department. In adult population, chronic non-palliated congenital heart lesions present new difficult situations for the anesthesiologist working with high-risk obstetric anesthesia. This case report makes a successful cesarean section in a CHD patient in emergency condition. A 27 year old female from Rio de Janeiro, Brazil; Gravida 1, Para 0, at 30 weeks gestation age was admitted to Pedro Ernesto University Hospital (HUPE) high risk maternity ward in Rio de Janeiro, she had a history of endocarditis in 2005. The patient was diagnosed with a complete placenta previa and was admitted to have a scheduled cesarean section. At 31 weeks of gestation the patient presented vaginal bleeding, the probable diagnosis was of placenta previa bleeding and emergency cesarean section was indicated. The anesthesia technique was general anesthesia with inhaled and intravenous anesthetic agents in rapid sequence induction. The newborn was delivered quickly with APGAR score 8 after 5 minutes. Postoperatively, the patient was admitted to the intensive care unit (ICU) for close monitoring of vital signs and post-operative care. The case report will include details in pre-operative, peri-operative and post-operative outcome of the patient.
Highlights
Medical advances in the past 40 years have increased survival and decreased morbidity of patients with a variety of clinical disorders
Patients with Congenital heart disease (CHD) are more at risk for obstetric complications and have a higher morbidity during surgical procedures
We will discuss the case of a young patient with CHD that had an obstetrical complication undergoing Caesarean section in emergency condition
Summary
Medical advances in the past 40 years have increased survival and decreased morbidity of patients with a variety of clinical disorders. With conservative or surgical therapies, children with CHD can reach adulthood end up resuming a normal life. These patients reach childbearing age and represent an enormous challenge to obstetricians and anesthesiologists alike. Patients with CHD are more at risk for obstetric complications and have a higher morbidity during surgical procedures. Our objective is to discuss the current anesthetic management of pregnant patients with uncommon congenital cardiac condition. We will discuss the case of a young patient with CHD that had an obstetrical complication undergoing Caesarean section in emergency condition. Understanding the physiology of pregnancy and the patho-physiology of the underlying cardiac disease is important when providing anaesthesia for high-risk obstetric patients. We hope to help other clinicians in their management of patients with CHD
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