Anaes SAQs · Obstetric anaesthesia
Severe aortic stenosis in pregnancy: delivery anaesthetic plan
Final-examination SAQ.
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ANZCAFRCAEDAICABAFCAI
Prompt
A woman with severe symptomatic aortic stenosis is planned for caesarean at 36 weeks after MDT review. Outline risk stratification principles, haemodynamic goals, anaesthetic technique options with vasopressor choice, monitoring, and postpartum risks.
Model answer
Risk and MDT (4). Cardiac disease carries major indirect-mortality importance; use ESC/mWHO frameworks and pregnancy heart team planning in a tertiary centre.[1][2]
Goals and technique (7). Maintain SVR, sinus rhythm, avoid tachycardia and abrupt venodilation; carefully titrated neuraxial (CSE/epidural) or carefully managed GA; phenylephrine for hypotension (SVR support favouring slower rates); arterial line; left tilt.[1][5]
Postpartum (4). Autotransfusion and fluid shifts, HDU, arrhythmia and failure vigilance.[1]
References5ShowHide
- [1]Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018.PMID 30165544
- [2]Freedman RL, Lucas DN MBRRACE-UK: saving lives, improving mothers' care - implications for anaesthetists. Int J Obstet Anesth, 2015.PMID 25841640
- [3]Regitz-Zagrosek V 'Ten Commandments' of the 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J, 2018.PMID 30219880
- [4]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia, 2015.PMID 26449292
- [5]Lee A, Ngan Kee WD, Gin T A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg, 2002.PMID 11916798