Presented in part at the Society for Obstetric Anesthesia and Perinatology Annual Meeting, Monterey, CA, May 2012.
Peripartum outcomes and anaesthetic management of parturients with moderate to complex congenital heart disease or pulmonary hypertension*
Article first published online: 5 NOV 2012
Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland
Volume 68, Issue 1, pages 52–59, January 2013
How to Cite
Maxwell, B. G., El-Sayed, Y. Y., Riley, E. T. and Carvalho, B. (2013), Peripartum outcomes and anaesthetic management of parturients with moderate to complex congenital heart disease or pulmonary hypertension*. Anaesthesia, 68: 52–59. doi: 10.1111/anae.12058
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- Issue published online: 11 DEC 2012
- Article first published online: 5 NOV 2012
- Manuscript Accepted: 21 SEP 2012
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.