الفهرس | Only 14 pages are availabe for public view |
Abstract The prevalence of heart disease in pregnancy has remained relatively constant over the last several decades, with reported incidence between 0.4 - 4.1 %. It represents now the joint most common cause of non-obstetric mortality in pregnancy, and accounting for 10 - 15% of maternal deaths. The common ailments in pregnancy are: congenital cardiac problems i.e. VSD, ASD, PDA, TOF, and Eisenmanger’s syndrome; valvular heart disease, i.e. MS, MR, AS and AR; other cardiac conditions associated with pregnancy are PH, IHD, PPCM and arrhythmias. Anesthetic management of the pregnant patient with heart disease represents a unique challenge for the anesthesiologist. This is because; the physiological dramatic changes associated with pregnancy cause significant hemodynamic changes that impose an additional burden on cardiac patient, especially around the time of labor and in the immediate puerperium. Parturients with significant cardiovascular disease should be managed by a multidisciplinary team at a high-risk medical center where around-the-clock coverage is provided by specialists in perinatology, cardiology, cardiac surgery, nursing, obstetrics and anesthesiology. The decision regarding the type of anesthesia for cesarean section will be guided by the nature and severity of the heart lesion as well as by the urgency of surgical delivery. Both regional and general anesthesias have been described in most cardiac conditions. The priority is clearly the mother and her cardiovascular stability. Moreover, the belief is that the most important is the care used with each technique, rather than the technique itself. |