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The Role of the Cardiac Consultation in the Care of Obstetrical Patients with Heart Disease
Abstract Number: 37
Abstract Type: Original Research
Cardiac disease is a major cause of maternal mortality and morbidity. Pregnancy, labor, and the postpartum period impose exceptional burdens to the parturient with cardiac dysfunction. These patients are often referred for cardiac evaluation by obstetricians and anesthesiologists. An investigation by Katz et al. (1) of the general population with heart disease (no pregnant women), verified that a significant disagreement occurred among anesthesiologists and surgeons on the utility of cardiac consultation, and that little of the advice generated by the consultation affected anesthetic management of the patients. No previous study has evaluated the role of cardiac consultation in the obstetric population. The goals of this study were to evaluate whether obstetric patients with cardiac pathology at our hospital were referred to a cardiologist, whether specific recommendations were made, and whether anesthetic management was affected.
Following IRB approval, a retrospective review of obstetric patients with a diagnosis of cardiac disease during the time period January 1, 1999 thru September 1, 2009 was performed. One hundred-sixty patients were in the database, 111 records were reviewed, and 79 complete chart reviews were included in our analysis. The most common diagnoses were cardiomyopathy (13.9%), supraventricular tachycardia (11.4%), mitral regurgitation (11.4%) and bicuspid aortic valve (6.3%).
Of the 79 complete chart reviews, 62 (79%) of the patients were evaluated by a cardiologist at least once during their pregnancy. Cardiologists made 121 recommendations. The most common recommendations were medication changes (28.9%), consideration of invasive line placement (12.3%), close hemodynamic monitoring (8.3%) and careful fluid management (8.3%). Twenty-eight new medications were suggested; 11 drugs were discontinued. Beta blockers were the most commonly added and discontinued medication. In three cases the method of anesthesia/analgesia was recommended. Two consultations resulted in no suggestions. Thirty-two echocardiograms were performed as a result of the consultation.
Although the cardiology consultation may have been helpful to the obstetricians, our data is similar to previous research (1,2) in that recommendations were of little value to the anesthesiologist for perioperative management. Assessing the need for invasive line placement, careful hemodynamic monitoring, and careful fluid management are integral parts of the daily routine of an anesthesiologist. Many recommendations were obvious or routine. In most cases, anesthesiologists feel confident in their ability to plan for and manage the risks and complications of parturition.
1. Katz R, et al. Anesth Analg 1998;87:830-6.
2. Kleinman B, et al. Journal of Cardiothoracic Anesthesia. 1989;3:682-7.
3. Curtis, S et al. International Journal of Cardiology 2009;133:62-9.