Anesthesia for Pregnant

Mothers with Cardiac Diseases

Presentor: Dr. Amare, year 3 ACCPM R

Case presentation

 A 35 year old G2P1( alive, C/D) mother were scheduled for elective C/D,
whose GA from 2nd TM ultrasound was 39 weeks. She had routine regular ANC
follow-ups where all routine investigations were done and uneventful.

 She took iron supplements and TT vaccine as well

 She has been a known cardiac patient for the past three years taking
metoprolol 25mg PO twice daily, initially diagnosed within two weeks
following her delivery.
Cont’d
 At that time she was admitted to the hospital after she presented with
generalized body swelling, easy fatiguability, SOB, and orthopnea and was told
to have DCMP.

 For this she was managed and has got improvements and metoprolol has been
started.

 Then after she has no cardiac symptoms and she is on cardiac follow-up
Cont’d
 She has also been a known type 2 diabetic patient for the past year on diet
modification and not taking any medication for her elevated sugar level.

 Otherwise she has no danger signs of pregnancy

 She has no history of fever, cough, asthma or HTN

 Her first delivery was via C/D under SA and there were no complications

 She can able to walk more than two flights of stairs without difficulty.

 Her pregnancy was planned and supported

Physical examinations

 GA well looking

 V/S BP 110/80 PR 82 RR 20 PSo2 93% at room air

 Weight 84kg height 148cm BMI= 38.3 kg/m2

 Airway: reassuring

 Chest: clear and resonant

 CVS: S1 & S2 well heard

 ABD: term-sized gravid uterus. FHB +ve

 MSS: no edema; palpable spinous process

Investigations

 WBC 6.4k HGB 13.6 Plt 161k

 Cr 0.7 urea 24 LFT WNR HgA1c 7.31 FBs 127

 Echo ; IHD with mild LV systolic dysfunction EF 40-45%

 there are basal anteroseptal, inferior and anteroseptal LV wall akinesis

 TAPSE 24mm

 With the assessment of;

 Primiparous+ Full term + 1 Prev C/S Scar + IHD With Mildly Reduced EF +
Poorly Controlled Type2dm + Class 2 Obesity + ASA3 + MG1 + MET>4 + WHO
Class 3 High Risk Mother
 The C/S delivery was done under CSE anesthesia

 Monitors were, ASA standard + Aline

 UOP= 0.78ml/kg/hr

 RBS was measured hourly

 There were two episodes of hypotension which required phenylephrine 25mg

bolus doses of each. Otherwise, there were no other complications.
 Her delivery was uneventful to effect of a male alive neonate with APGAR of 7
and 9 and whose weight was 5kg.

 Baby was transferred to NICU for large for GA and baby of DM mother

 Mother was transferred to PACU

TIME FOR DISCUSSION!!

ANY COMMENT AND QUESTIONS?