///2016 Abstract Details
2016 Abstract Details2019-07-15T10:10:51-05:00

Mode of delivery and anesthetic management outcomes in Patients with congenital and acquired cardiac disease (CACD)

Abstract Number: F-34
Abstract Type: Original Research

STEPHANIE LIM MD1 ; Erin Washburn MD2; Juan Gonzalez-Velez MD3; Ian Harris MD4; Michelle Moghadassi MPH5; Jennifer Lucero MD6

Background: It is well accepted that pregnant patients with congenital and acquired cardiac disease (CACD) have unique obstetric and anesthetic challenges. The optimal management of these patients during labor and delivery is not well understood. This study compares mode of delivery, obstetric outcomes, and type of intrapartum anesthesia for CACD and healthy controls.

Methods: We performed a retrospective cohort analysis of women with CACD who were managed by our multidisciplinary (PACT) team during 2008 to 2013. PACT team includes Maternal Fetal Medicine, Obstetric Anesthesia, and Congenital Cardiology. Our congenital cardiologist then categorized these patients as either complex congenital (C-CHD) or non-complex congenital (nonC-CHD) according to the ACC/AHA 2008 guidelines. NonC-CHD patients include both non-complex congenital and acquired HD. Controls consisted of all healthy nulliparous women with singleton, vertex pregnancies who delivered after 36 wks (GA) during the same time period.

Result: We identified 140 women with CACD who delivered at UCSF, including 43 (31%) with C-CHD and 97 (69%) with nonC-CHD. Our mean GA at delivery was 37.3 wks. 68% of C-CHD and 81% of nonC-CHD delivered at GA ≥36weeks. We analyzed 101 CACD patients who were either nulliparous or parous (without cesarean delivery (CD)). We found elective and non-elective CD rates were lower among CACD compared to our controls (14% vs 20%) and significantly more operative vaginal deliveries (VD) within the CACD group compared to controls (28% vs 12%). There was no significant difference for epidural analgesia use although controls used more nitrous oxide compared to CACD patients (18% vs. 9%). No maternal or neonatal deaths occurred with CACD patients. After delivery, only 8% of C-CHD and 10% of nonC-CHD were admitted to the ICU.

Conclusion: In this relatively large cohort of pregnant women with CACD, the majority were able to have VD with a low rate of maternal morbidity. Use of epidural anesthesia did not differ between the two groups, but controls had increased utilization of intrapartum nitrous oxide. Future analyses of our data will explore indications for operative VD and neonatal outcomes in the PACT patients.

Reference:

1. ACC/AHA 2008 guidelines for the management of adult with congenital heart disease. Circulation. 2008: 118:e714-e833



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