title: Management of Complex Cardiac Issues in the Pregnant Patient.
abstract: Management of peripartum heart disease in the intensive care unit requires optimization of maternal hemodynamics and maintenance of fetal perfusion. This requires fetal monitoring and should address the parturient's oxygen saturation, hemoglobin, and cardiac output as it relates to uterine blood flow. Pharmacologic strategies have limited evidence pertaining to hemodynamic stabilization and fetal perfusion. There is some evidence that surgical management of critical mitral stenosis should be percutaneous when possible because cardiac bypass is associated with increased fetal mortality. Fetal monitoring strategies should address central organ perfusion because peripheral scalp pH has not been associated with improved fetal outcomes.
authors.affiliation: Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT, USA. Electronic address: Huayong.hu@gmail.com.
authors.forename: Huayong
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
authors.forename: Ioana
authors.initials: I
authors.lastname: Pasca
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods / Q000592:standards; D004195:Disease Models, Animal; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D046689:Fetal Mortality; D005333:Fetus / Q000502:physiology* / Q000503:physiopathology; D006801:Humans; D008431:Maternal-Fetal Exchange / Q000187:drug effects / Q000502:physiology*; D010101:Oxygen Consumption / Q000502:physiology; D021041:Placental Circulation / Q000502:physiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000628:therapy*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012756:Sheep
chemical_list: D000925:Anticoagulants
keywords: Fetal monitoring; Fetal oxygenation; ICU management of cardiac disease during pregnancy; Valvular heart disease during pregnancy; Vasopressor effects on fetal oxygenation