title: Peripartum outcomes and anaesthetic management of parturients with moderate to complex congenital heart disease or pulmonary hypertension*.
abstract: We performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12-year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliveries, respectively. The caesarean delivery rate was 43% compared to our institution average of 27% over the same period (p = 0.02), and 38% had operative vaginal deliveries compared to a 10.5% institution rate (p < 0.01). Invasive monitoring was used in 28% of all deliveries. There were one maternal and two neonatal deaths. This study provides detailed anaesthetic and peripartum management of women with congenital heart disease, a patient population in whom evidence-based practice and data are largely lacking. We observed a predominance of neuraxial anaesthetic techniques, increased caesarean and operative delivery rates, and favourable maternal and neonatal outcomes. Multicentre studies and registries to compare anaesthetic and obstetric management strategies further and delineate risk factors for adverse outcomes are required.
authors.affiliation: Adult Cardiothoracic Anaesthesia, Stanford University School of Medicine, Stanford, CA, USA. bmaxwell@stanford.edu
authors.forename: B G
authors.initials: BG
authors.lastname: Maxwell
authors.forename: Y Y
authors.initials: YY
authors.lastname: El-Sayed
authors.forename: E T
authors.initials: ET
authors.lastname: Riley
authors.forename: B
authors.initials: B
authors.lastname: Carvalho
mesh_terms: D000022:Abortion, Spontaneous; D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data; D003490:Cyanosis / Q000453:epidemiology; D016208:Databases, Factual; D036861:Delivery, Obstetric; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000151:congenital*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D007226:Infant Mortality; D007231:Infant, Newborn; D054238:Perinatal Mortality; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy; D011256:Pregnancy Outcome; D012189:Retrospective Studies