Regional anaesthesia in pregnant women with cardiovascular diseases

Background. Currently in developed countries, up to 4 % of pregnant women have cardiovascular diseases, which are one of the leading causes of maternal mortality. Anesthesia method have an important role in the abdominal delivery in this category of patients.

 Objective. To summarize the experience of different anesthesia approaches to abdominal delivery in pregnant women with cardiovascular diseases.

Materials and methods. A retrospective analysis of the use of various methods of anesthesia during abdominal delivery of pregnant women with cardiovascular diseases was performed.

Results. In “Maternity Hospital № 13” and the Almazov National Medical Research Centre for the period from 2014 to 2018 2140 abdominal deliveries were carried out in pregnant women with heart diseases (1450 and 690, respectively). In the Maternity Hospital №13 1374 (94.8 %) of abdominal deliveries were performed under regional anesthesia, 76 (5.2 %) under general anesthesia. In Almazov National Medical Research Centre 513 (74.3 %) of abdominal deliveries were performed under regional anesthesia, 177 (25.7 %) under general anesthesia. The features of the hemodynamic profile of general and regional anesthesia in pregnant women with various heart disease are presented.

Conclusion. In pregnant women with heart disease, up to 88 % of cesarean section are performed under regional anesthesia. General anesthesia is used for contraindications to regional anesthesia, as well as for obstetric indications. The use of advanced monitoring, methods of slow titration of local anesthetic dose and the use of vasopressors allow to avoid hemodynamic disorders in patients with concomitant heart disease.

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