Anesthetic Management for Cesarean Delivery in Women with Fontan Circulation: A Single-Center Retrospective...

Advances in surgical techniques have enabled women with Fontan circulation to reach childbearing age. However, data on anesthetic management for cesarean delivery in this population are limited. This study aimed to evaluate anesthetic management and perioperative outcomes in pregnant women with Fontan circulation undergoing cesarean delivery.

Single-center retrospective observational study.

A single tertiary university hospital.

Pregnant women with Fontan circulation who underwent cesarean delivery.

Data on obstetric and anesthetic management, as well as maternal outcomes, were analyzed. We identified 15 cesarean deliveries in 13 women with Fontan circulation. The median maternal age was 30 years (range, 23-37 years), and the median gestational age was 34 weeks and 3 days (range, 26 weeks and 4 days to 37 weeks). Subchorionic hematomas occurred in 11 patients, and arrhythmias during pregnancy were observed in 6 patients. Cesarean deliveries were managed with neuraxial anesthesia in 7 cases (6 single-shot spinal and 1 combined spinal-epidural) and with general anesthesia in 8 cases. Prophylactic dopamine infusion was administered to 7 patients who received neuraxial anesthesia and 5 patients who received general anesthesia. Intraoperative hypotension was defined as a decrease in systolic blood pressure to <80% of the preoperative baseline. No hypotension occurred under neuraxial anesthesia, even with standard intrathecal doses. In contrast, transient hypotension occurred in 6 patients receiving general anesthesia but was promptly managed with vasoactive agents. Postoperatively, 7 patients (3 from the general anesthesia group and 4 from the neuraxial group) developed heart failure necessitating diuretics. All patients were discharged in stable condition.

Both neuraxial and general anesthesia were performed without major adverse events, suggesting that either approach may be feasible in women with Fontan circulation undergoing cesarean delivery; however, the findings should be interpreted with caution, given the small sample size.