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Anesthetic Treatment of Cardiac Disease During Pregnancy

  • Kate M. Cohen
  • Rebecca D. Minehart
  • Lisa R. Leffert
Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
  • 131 Downloads
Part of the following topical collections:
  1. Topical Collection on Pregnancy and Cardiovascular Disease

Abstract

Purpose of review

This review summarizes the pathophysiology, peripartum treatment, and anesthetic management of parturients with cardiac disease. Valvular disease, coronary disease, and cardiomyopathy are specifically addressed in the context of the normal physiologic changes of pregnancy. We offer recommendations for anesthetic approaches, hemodynamic goals with an emphasis on interdisciplinary planning between anesthesiologists, cardiologists, cardiothoracic surgeons, obstetricians, maternal fetal medicine specialists, and neonatologists.

Recent findings

Vaginal delivery with neuraxial analgesia can be well tolerated by many pregnant patients with cardiac disease when coordinated by an interdisciplinary team of experts.

Summary

Cardiac disease in pregnancy can present a significant challenge for the interdisciplinary care team. A detailed understanding of each patient’s cardiac pathology and the physiologic changes of pregnancy are critical to ensure a safe and successful labor and delivery. Optimized medical therapy in the peripartum period and neuraxial anesthesia with the judicious use of vasoactive agents can be of great benefit for these parturients. As is generally the case, cesarean delivery should be primarily reserved for obstetric indications and maternal wellbeing, with careful consideration of the fetus to guide best practices.

Keywords

Obstetric anesthesia Cardiac disease Valvular disease Peripartum cardiomyopathy Labor analgesia 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kate M. Cohen
    • 1
  • Rebecca D. Minehart
    • 1
  • Lisa R. Leffert
    • 1
  1. 1.Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General HospitalBostonUSA

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