///SOAP 2019 Maternal Cardiac Disease Delivery Planning Algorithm/Framework
SOAP 2019 Maternal Cardiac Disease Delivery Planning Algorithm/Framework2019-04-18T20:30:23-06:00

SOAP 2019 Maternal Cardiac Disease Delivery Planning Algorithm/Framework

Marie-Louise Meng, MD and Katherine Arendt, MDelcome to SOAP’s CMEs

1.       WHO: (patient and medical team)

A.       Patient:

·       Medical, surgical, obstetric (fetal), anesthetic history, medications (anticoagulation), allergies

·       Modified WHO scale (mWHO II-III, III, IV consider transfer to referral hospital)

·       CARPREG II Risk score (CARPREG >1 consider transfer to referral hospital)

·       NYHA Class I-IV

·       Other data: BNP, ECG, TTE, CT, MRI

B.       Team:

·       Obstetrician/Maternal Fetal Medicine

·       Anesthesiologist (Obstetric and Cardiothoracic)

·       Cardiologist

·       Neonatologist

·       Hematologist

·       Cardiothoracic surgeon

·       ECMO surgeon

·       Perfusionist

·       Intensivist

·       Critical Care Obstetric Nurse

·       Critical Care Nurse


2.       WHAT: (Route of delivery)

·       Vaginal v. Cesarean delivery v. Termination


3.       WHEN: Target induction/delivery/procedure date (gestational weeks/days):_________


4.       WHERE: (Type of medical center and location within medical center)

·       Local v. Referral hospital

·       L&D suite labor room, L&D operating room, cardiothoracic operating room, intensive care unit


5.       HOW: (Peripartum plan)

A.       Hemodynamic goals:

B.       Peripartum risks:

C.       Medications:

·       Vasopressors: phenylephrine, norepinephrine, vasopressin

·       Inotropes: dobutamine, dopamine, milrinone, epinephrine

·       Anti-pulmonary HTN: oxygen, calcium channel blockers, prostacyclin agonists, PDE-5 inhibitors, endothelin antagonists, nitric oxide-cyclic guanosine monophosphate enhancers, nitric oxide

D.       Anesthesia: spinal, combined spinal epidural, epidural, general

E.       Monitoring: non-invasive blood pressure, arterial line, telemetry, central venous pressure, pulmonary artery catheter, transthoracic echocardiogram, transesophageal echocardiogram

F.        Venous access: peripheral or central

G.      ECMO: VV or VA, back-up, place wires, place sheaths, place cannulas

H.      Hemorrhage prevention/management:

·       Uterotonics: oxytocin, methergine (avoid in HTN), carboprost (avoid in lung disease), misoprostol

·       Procedures: compression, suture, Bakri balloon, uterine artery embolization, hysterectomy

I.         Post care:

·       Recovery location: (ICU or high-risk maternal unit or post-partum unit)

·       Treatment goals:

                                                               i.      Diuresis for arrhythmia and heart failure prevention

                                                              ii.      Anticoagulation for thrombosis prevention

                                                            iii.      Stool softeners for prevention of Valsalva

                                                            iv.      Sodium restriction