Anaes · Obstetric anaesthesia
Cardiac disease in pregnancy: risk stratification and anaesthetic delivery planning
Also known as mWHO pregnancy cardiac risk · Heart disease pregnancy anaesthesia · Severe AS pregnancy delivery · Pulmonary hypertension pregnancy
Anaesthesia for cardiac disease in pregnancy: mWHO risk, multidisciplinary planning, lesion-specific haemodynamics, neuraxial versus GA, monitoring, and postpartum autotransfusion risk.
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Red flags
- Cardiac disease is a leading indirect cause of maternal death.
- Use mWHO/ESC frameworks and a pregnancy heart team.
- Severe AS/MS: maintain SVR, avoid tachycardia; phenylephrine often preferred.
- Pulmonary hypertension is extremely high risk.
- Plan postpartum autotransfusion and monitored disposition.
Meet the patient
A 32-year-old with known severe mitral stenosis is admitted at 34 weeks in fast atrial fibrillation, breathless and tachycardic. The obstetric team wants to deliver her tomorrow. Your job is not to pick a drug — it is to assemble the team, set the haemodynamic targets, and decide whether she delivers in a tertiary centre with cardiac anaesthesia and ICU on standby.[2][1]
The two questions that decide her safety are the two every cardiac pregnancy turns on: what is her mWHO risk class? and what does this lesion need me to protect — preload, afterload, rate, or pulmonary vascular resistance? Say those two aloud and every section below follows.[1][3]
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