title: Intrapartum obstetric management.
abstract: Maternal cardiac disease complicates approximately 1-2% of all pregnancies in the United States. Just as during the antepartum period, in the immediate period surrounding delivery, obstetrical patients with cardiac disease (both congenital and acquired) will have specialized needs, tailored to the patient and her specific lesion. While the basic principles of labor and delivery management protocols are relevant to this subgroup of patients, there are certain areas in which adjustments must be made. These include endocarditis prophylaxis, recent anticoagulation, fluid management, and the need for increased maternal cardiac monitoring. Awareness of the challenges of the intrapartum period combined with a multi-disciplinary approach from anesthesia, cardiology, and the obstetrical provider will optimize the patient for a safe delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W 168th St, PH-16, New York, NY.
authors.forename: Heather
authors.initials: H
authors.lastname: Levin
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W 168th St, PH-16, New York, NY. Electronic address: apl1@columbia.edu.
authors.forename: Anita
authors.initials: A
authors.lastname: LaSala
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use*; D002300:Cardiac Care Facilities / Q000458:organization & administration*; D002585:Cesarean Section; D002985:Clinical Protocols; D000075202:Contraindications; D036861:Delivery, Obstetric; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006331:Heart Diseases / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D009035:Mothers; D010138:Pacemaker, Artificial; D019990:Perioperative Care; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology / Q000628:therapy*; D018566:Pregnancy, High-Risk; D014481:United States
chemical_list: D000925:Anticoagulants
keywords: analgesia; anticoagulation; cardiac disease; cesarean delivery; endocarditis prophylaxis; fluid management; heart; hemodynamic monitoring; hemorrhage; intrapartum; labor; operative delivery; oxygen supplementation; pacemakers/AICD; postpartum; pregnancy; pregnancy physiology