Perioperative Management of Obstetrical Surgeries in Women Having Coexisting Cardiovascular Disease: Our Experience

Abstract

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. The 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 from 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% of cases were done under subarachnoid block. Most of the patient needed postoperative 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 a pulmonary artery catheter or continuous cardiac output monitoring. Conclusion: Pregnant patients with the coexisting cardiovascular disease need multidisciplinary approach, timely delivery and intensive therapy in the perioperative period. They can be safely delivered under subarachnoid blocks. Pulmonary artery catheterization is probably not essential for hemodynamics management of such patients in perioperative management.