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Cardiac disease in pregnancy

Steffen Rex1, Sarah Devroe1

  • 1Department of Anaesthesiology, University Hospitals Leuven (BE), Department of Cardiovascular Sciences, KU Leuven (BE), Herestraat 49, B-3000 Leuven, Belgium.

Best Practice & Research. Clinical Anaesthesiology
|June 6, 2022
PubMed

Insights

Cardiovascular disease is the leading cause of death in pregnant and postpartum individuals. Anesthesiologists must understand cardiac pathophysiology for optimal management, preferring neuraxial anesthesia when possible.

Area of Science:

  • Obstetrics and Gynecology
  • Cardiology
  • Anesthesiology

Background:

  • Cardiovascular disease (CVD) is the primary cause of mortality in pregnancy and postpartum in developed nations.
  • Increasing maternal age, comorbidities, and lifestyle factors contribute to rising CVD incidence.
  • Pregnancy imposes significant physiological stress on the cardiovascular system, exacerbated by obstetric medications.

Purpose of the Study:

  • To highlight the critical role of anesthesiologists in managing pregnant patients with cardiovascular disease.
  • To emphasize the importance of understanding cardiac pathophysiology for anesthetic care.
  • To provide guidance on anesthetic techniques for labor and delivery in this high-risk population.

Main Methods:

  • Review of current literature on cardiovascular disease in pregnancy.
  • Discussion of physiological changes during pregnancy affecting the cardiovascular system.
  • Analysis of anesthetic management strategies for pregnant patients with CVD.

Main Results:

  • Cardiovascular disease has surpassed obstetric complications as the leading cause of maternal death.
  • Multidisciplinary heart team management, including anesthesiologists, is crucial.
  • Neuraxial anesthesia is recommended for labor and delivery when not contraindicated.

Conclusions:

  • Anesthesiologists require profound knowledge of cardiac pathophysiology for safe patient care.
  • Neuraxial anesthesia techniques are favored for labor and cesarean delivery due to similar maternal outcomes compared to general anesthesia.
  • Careful consideration of non-cardiac contraindications is essential when selecting anesthesia.

Keywords:
anaesthesiacardiovascular diseasespregnancy

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