Management of a parturient with cardiac valve prosthesis

The parturient with a cardiac valve prosthesis presents a twofold problem of management: (1) that of a rising cardiac workload in the presence of serious heart disease, and (2) that of chronic anticoagulant therapy. Pain relief, a shortened 2nd stage of labor, and avoidance of bearing-down efforts reduce stress. Vaginal delivery is preferred to cesarean section, and segmental lumbar extradural block is the optimal anesthetic method. Oxytocics must be used with caution and heparin is preferred to longacting oral anticoagulants.