Uterine blood flow increases progressively throughout pregnancy and reaches about 500 ml/min at term. Thus, each uterine contraction causes increased venous return. Right after delivery and placenta expulsion, uterine involution and termination of placental circulation cause an autotransfusion of approximately 300–500 mL of blood. Therefore, intrapartum is one of the peak times when heart failure occurs in women with cardiovascular disease.
Timing of delivery and mode of delivery should be decided in individual cases. Vaginal delivery is preferred, even among women with cardiovascular disease, and Cesarean delivery is reserved for obstetric indications. However, there are several high-risk conditions in which Cesarean section is recommended, such as Marfan syndrome with significantly dilated aorta. The use of regional anesthesia in labor and assisted vaginal delivery can reduce intrapartum hemodynamic changes. High-risk labors require specific expertise and collaborative management by skilled obstetricians, cardiologists, anesthesiologists, and neonatologist in experienced maternal–fetal medicine units.
KeywordsLabor Anesthesia Vaginal delivery Cesarean section Heart failure
- 5.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) (2011). https://doi.org/10.1093/eurheartj/ehr218.