Anesthetic management of a consecutive cohort of women with heart disease for labor and delivery.
BACKGROUND
The cardiovascular changes of pregnancy may place additional stress upon women with pre-existing heart disease, increasing peripartum morbidity and mortality. The purpose of this descriptive study was to report the anesthetic management of a large cohort of pregnant women with heart disease.


METHODS
The medical records of 522 consecutive parturients (657 pregnancies) with heart disease who delivered at Toronto General Hospital or Mount Sinai Hospital in Toronto, Ontario, Canada between 1986 and 2004 were reviewed. Obstetric, medical and anesthetic management data were collected and the women were stratified by New York Heart Association (NYHA) functional status at delivery. The main outcome of interest was the method of analgesia or anesthesia administered during labor and delivery. Univariate and multivariate analysis was performed to identify risk factors associated with the administration of general anesthesia.


RESULTS
Of 657 pregnant women, 602 were NYHA 1/2 and 55 were NYHA 3/4 at time of delivery. Epidural analgesia was administered to 84% of NYH 1/2 women and 83% of NYH 3/4. The cesarean section rates were 29% and 31% respectively. The rate of general anesthesia for the entire cohort was 9%. Factors associated with the use of general anesthesia for operative delivery included cesarean delivery (adjusted O.R. 74; 95% CI 9.5, 573), delivering at Toronto General Hospital site (adjusted O.R. 5.5; 95% CI 2.3, 13.3), presence of complex congenital heart lesion (adjusted O.R. 2.3; 95% CI 1.0, 5.4) and each week of premature delivery (adjusted O.R. 1.3; 95% CI 1.1, 1.5). Three percent suffered intrapartum cardiac complications; there was one death.


CONCLUSIONS
Pregnant women with heart disease managed within an organized program may undergo labor and delivery with acceptable rates of complications. Cesarean section, epidural analgesia/anesthesia and general anesthesia rates are similar to those in the general obstetric population.
Goldszmidt
E
E
Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Ontario, Canada. e.goldszmidt@utoronto.ca
Macarthur
A
A
Silversides
C
C
Colman
J
J
Sermer
M
M
Siu
S
S
D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D005316:Fetal Distress / Q000150:complications; D005865:Gestational Age; D006801:Humans; D007746:Labor Presentation; D007743:Labor, Obstetric / Q000502:physiology; D016343:Monitoring, Intraoperative; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome