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PARTURIENT WITH INTERSTITIAL LUNG DISEASE COMPLICATED BY PULMONARY HYPERTENSION UNDERGOING CESAREAN DELIVERY
Abstract Number: RF2AB-267
Abstract Type: Case Report Case Series
INTRODUCTION: Interstitial lung disease (ILD) is the term given to a group of diseases causing inflammation and thickening of the alveoli eventually leading to pulmonary hypertension and cor pulmonale1 Patients with ILD, hypoxemia, and secondary pulmonary hypertension are at increased risk during pregnancy and require careful, multidisciplinary planning to ensure safe peripartum care.
CASE: A 37 year old female G1P0 at 34weeks of gestation with obesity, hypoventilation syndrome, interstitial pulmonary fibrosis, pulmonary hypertension on home oxygen, preeclampsia, anemia, and gestational diabetes was admitted for imminent delivery. Given her worsening hypoxia and hypercapnia, she was being maintained with BiPAP . The operative plan was discussed with a multidisciplinary team that included obstetrics, maternal fetal medicine, obstetrical anesthesia, pulmonology, and critical care. Decision was made to use a low dose combined spinal epidural anesthetic with a pre-procedure arterial line and PICC line.Close monitoring of her respiratory status was undertaken and BiPAP was employed intra operatively. Use of an extra corporeal membrane oxygenator (ECMO) and pulmonary artery catheter were discussed and on standby. Pre-operative oxygen saturation 96% on BiPAP . In the operating room standard ASA monitors were attached and an arterial line was placed. A combined spinal epidural anesthetic was employed at L3-4 level and 1 ml of 0.75% hyperbaric bupivacaine with 10 mcg of fentanyl was placed intrathecally. The epidural catheter was then judiciously bolused to achieve a T4 level. Vasopressin and norepinephrine infusion were used to bring the blood pressure back to baseline. No desaturation or significant hypotension occurred intraoperatively. Post-operative pain control was maintained via a continuous epidural infusion. DISCUSSION: Women with severe restrictive lung diseases such as interstitial lung disease were historically advised to avoid pregnancy. However in light of recent advances in medicine, more flexibility and options exist for patients desiring pregnancy. There is no specific anesthesia type for the patient with ILD, however the CSE technique was chosen for our patient to allow for surgical anesthesia and in taking in consideration of a high risk of postoperative pulmonary complications
References 1. Novikova,L et.al., (2014), European Respiratory Journal ,3763.
2. Giattino SL, et. al. (2018) Arthritis Rheumatic. 70