Induction of Labour in Pregnancy Complicated by Cardiac Disease
Article first published online: 28 JUN 2008
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 33, Issue 1, pages 37–39, February 1993
How to Cite
Sau, A. K., Vasishta, K., Dhar, K. K. and Khunnu, B. (1993), Induction of Labour in Pregnancy Complicated by Cardiac Disease. Australian and New Zealand Journal of Obstetrics and Gynaecology, 33: 37–39. doi: 10.1111/j.1479-828X.1993.tb02049.x
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
EDITORIAL COMMENT": We accepted this paper for publication so readers could review their thoughts on induction of labour in women with cardiac disease; a series of 450 women with organic heart disease during pregnancy was required to provide the 21 cases presented. A woman with cardiac disease can rapidly go into heart failure after delivery and, since a physician is never present fin the editor's experience) the obstetrician must know what to do in this circumstance. Prophylaxis is preferable. Therefore all except Grade I cases (murmur without symptoms) merit delivery in the sitting position with the legs held horizontally by 2 assistants; oxygen and morphine should be available and aminophylline 250–500 mg by slow intravenous injection is one regimen used to anticipate and prevent the onset of failure with delivery of the placenta. These women withstand blood loss poorly and, in our view, intravenous oxytocin 5–10 units is recommended after completion of the second stage. If cardiac failure occurs the woman should be sat upright, given oxygen, morphine 15 mg preferably intravenously, and digitalized(1 mg in divided doses. I. V. over 24 hours). Intravenous frusemide (40–80 mg) is a rapidly-acting diuretic that is also recommended and was given as a routine to all women in the present study, the drug being administered at the time of induction and at the onset of the second stage of labour.
Summary: Twenty one pregnant patients with cardiac disease had induction of labour for various obstetric reasons with a modified oxytocin infusion method. All of them went into labour and delivered within 20 hours. Twenty patients delivered vaginally. Three neonates had birth asphyxia (Apgar score < 7) and 1 of them died on the 4th day from prematurity. No adverse effect of oxytocin infusion on maternal cardiac status was observed and all of the women went home in good condition. Induction of labour with a modified oxytocin infusion is a safe and effective alternative for selected gravidas with cardiac disease where elective delivery is warranted.