title: [Anaesthetic management of caesarean section in pregnancy with diabetes and hypertrophic myocardiopathy with restrictive diastolic dysfunction].
abstract: Haemodynamic changes that occur during pregnancy are maximal between 28 and 34 weeks. In the pregnant woman with several associated diseases, such as hypertensive myocardiopathy and pre-gestational diabetes, these changes can lead to a difficult control of pulmonary hypertension and acute pulmonary oedema. We report the case of a pregnant woman with long term type 1 diabetes mellitus who suffered pre-eclampsia in a previous pregnancy, and since then developed hypertensive cardiomyopathy. She was admitted at 30 week gestation for metabolic and blood pressure control, and developed congestive cardiac failure after the administration of betamethasone for foetal lung maturity. A transthoracic echocardiogram showed a non-dilated hypertrophic left ventricle with good systolic function, restrictive diastolic dysfunction and moderate pulmonary arterial hypertension. When her general condition improved, we performed a caesarean section under regional anaesthesia to prevent the complications of pulmonary and systemic hypertension. We present the anaesthetic management and resolution of complications after oxytocin administration.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario de Tarragona Juan XXIII, Tarragona, España. miriamholgado@yahoo.co.uk
authors.forename: C M
authors.initials: CM
authors.lastname: Holgado
authors.forename: S
authors.initials: S
authors.lastname: Coves
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D001623:Betamethasone / Q000009:adverse effects; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000188:drug therapy; D002317:Cardiovascular Agents / Q000627:therapeutic use; D017604:Cesarean Section, Repeat; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003971:Diastole; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000139:chemically induced / Q000188:drug therapy; D009638:Norepinephrine / Q000627:therapeutic use; D010121:Oxytocin / Q000009:adverse effects; D010656:Phenylephrine / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000503:physiopathology; D011229:Preanesthetic Medication; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy / Q000503:physiopathology*; D011254:Pregnancy in Diabetics; D016683:Supine Position
chemical_list: D002317:Cardiovascular Agents; D010656:Phenylephrine; D010121:Oxytocin; D001623:Betamethasone; D009638:Norepinephrine