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Anesthetic and obstetric management of women with cardiac failure in pregnancy: A retrospective cohort study
Abstract Number: F2B-4
Abstract Type: Original Research
International registry data quote the incidence of cardiac failure (CF) in pregnant women with pre-existing cardiac disease at 13.1% with up to 10% requiring hospitalization. As CF may affect women with no history of cardiac disease, we explored CF in all pregnancies presenting to an obstetric referral center. Our objective was to identify the incidence and causes of admission for CF in pregnancy at our institution and their obstetric and anesthetic management.
This retrospective cohort study was conducted on admissions at our institution (2004-2017) with a diagnosis of CF in pregnancy or immediate postpartum period. Hospital records and electronic databases were interrogated using International Classification of Diseases v10. CF was defined as symptoms (dyspnea) and signs of fluid retention (edema or crackles) requiring treatment (diuresis ± other therapies). Demographic data, investigations, treatment, obstetric and anesthetic management and maternal-fetal outcomes were collected and summarized using descriptive statistics.
Data on 32 pregnancies in 4-years (2014-2017) have been analyzed thus far (total deliveries = 27658). Most common causes of CF requiring admission were pre-eclampsia (n=8; 25%) and cardiomyopathy (n=7; 22%). In patients who developed CF, 56% (n=18) had no known prior cardiac condition. Women with known heart disease were identified antenatally and seen in specialist clinics (93%; n=13/14). Postpartum CF occurred in 47% (n=15).
In patients with an episode of antenatal CF, 12 had cesarean deliveries, of which 4 were indicated for maternal cardiac condition. Only 1 patient with antenatal CF required general anesthesia. Major morbidity occurred in 44% of this cohort, including 1 respiratory arrest. ICU or CCU admission was required in 41% of cases [Table 1].
Incidence of CF requiring admission was 1 in 864 deliveries at our institution. Whilst patients with known cardiac disease are seen in specialist clinics, it must be appreciated that CF requiring admission can occur in those with no pre-existing cardiac diagnosis. Pre-eclampsia appears to be associated with a significant proportion of CF admissions at our institution. Anesthetic and surgical techniques are tailored to individual patient condition through multidisciplinary input. The postpartum period is high risk and warrants a heightened level of attention.
2) Eur Heart J.2013;34:657–65