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Antenatal Anesthesia Clinic for Women with Concurrent Cardiac Disease
Abstract Number: F-37
Abstract Type: Original Research
Background. Concurrent cardiac disease has become a major contributor to maternal mortality. Labor and delivery in this population has unique implications. We report deliveries among women with concurrent cardiac disease who were pre-assessed in the antenatal anesthesia clinic (2006-14).
Methods. The antenatal anesthesia clinic enables women with concurrent cardiac disease to receive an anesthesia plan contingent on their cardiac status. With IRB approval, we reviewed the electronic medical records (EMR) for planned and actual labor anesthesia management of women with concurrent cardiac disease who had visited the clinic prior to delivery.
Results. We identified 375 women with concurrent cardiac disease (2006-2014) from the EMR; 37(9.9%) visited the clinic since inception. We categorized the women who visited the clinic according to disease pathology: arrhythmia (n=7), congenital disease with (n=13) or without correction (n=4), valve disease (with or without pulmonary hypertension) (n=11) and cardiomyopathy (n=2). Women’s ages ranged from 18-50, and for 4 women this was not their first delivery, (including 2 with cardiomyopathy). There were 23(57.5%) cesarean and 13(32.5%) vaginal deliveries; only one cesarean was performed under general anesthesia. Nine (24.3%) women had at least one further delivery; one woman (with a biological mitral valve) had 6 further deliveries.
Conclusion. The antenatal anesthesia plan for women with concurrent cardiac disease enabled us to plan prepare for these potentially complicated cases, however we identified a need to increase referrals, as less than 10% of women with concurrent cardiac disease were pre-assessed.
Table. Summary of characteristics of Pregnant Women with Concurrent Cardiac Disease seen in the Antenatal Anesthesia Clinic
Key: NYHA = New York Heart Classification of Disease; NB = Neuraxial Block; GA = General anesthesia; n = number