Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

• Published in: Canadian journal of anesthesia Vol. 62; no. 3; pp. 278 - 288
• Main Authors: Ituk, Unyime S., Habib, Ashraf S., Polin, Carrie M., Allen, Terrence K.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-03-2015; Springer Nature B.V
• Subjects: Academic Medical Centers; Adult; Anesthesia, Epidural; Anesthesia, General; Anesthesia, Obstetrical - methods; Anesthesia, Spinal; Anesthesiology; Cardiology; Cardiomyopathy; Cardiomyopathy, Dilated - complications; Cardiovascular disease; Case Reports; Case Series; Childbirth & labor; Critical Care Medicine; Delivery, Obstetric - methods; Delivery, Obstetric - statistics & numerical data; Epidural; Female; Fetal Death; General anesthesia; Gestational age; Heart; Heart Arrest; Hormones; Humans; Intensive; Labor, Obstetric; Maternal mortality; Medical personnel; Medicine; Medicine & Public Health; Multidisciplinary teams; Outcome and Process Assessment (Health Care) - statistics & numerical data; Oxytocics - administration & dosage; Oxytocin - administration & dosage; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Pregnancy; Pregnancy Complications, Cardiovascular; Vagina; Womens health; New York; United States > US; Dilate Cardiomyopathy; Cesarean Delivery; Peripartum Cardiomyopathy; Epidural Analgesia; Cardiac Intensive Care Unit
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-014-0290-y

Purpose
This study examines the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre over a seven-year period.
Principal findings
Twenty-five women were included in this series, 18 with a new diagnosis of cardiomyopathy and seven with a history of cardiomyopathy. Sixteen patients (64%) identified themselves as African American, seven (28%) were Caucasian, and two patients (8%) were Hispanic. The median (range) gestational age at the time of a new diagnosis of cardiomyopathy was 29 (7-38) weeks. Eight women (32%) had New York Heart Association class III/IV symptoms at the time of delivery or in the immediate postpartum period. A multidisciplinary team of obstetricians, anesthesiologists, cardiologists, and pediatricians were involved in the care of these women. The median (range) gestational age at the time of delivery was 33.5 (30-40) weeks. There were nine vaginal deliveries and 15 operative deliveries. One patient had fetal loss at 19 weeks gestation. Twelve women had labour induced with an intravenous infusion of oxytocin at a rate of 0.001-0.02 IU·min
−1
. An oxytocin infusion at a variable rate with a maximum dose of 0.05 IU·min
−1
was administered after vaginal delivery to maintain uterine tone. Epidural analgesia was initiated prior to induction of labour or in the latent phase of labour. Seven Cesarean deliveries were performed under combined spinal-epidural anesthesia, five were performed under epidural anesthesia, and three women had general anesthesia. Oxytocin was administered via an intravenous infusion at a rate of 0.05-0.2 IU·min
−1
after operative delivery. One patient had a cardiac arrest on induction of general anesthesia and was successfully resuscitated. There were no maternal or neonatal deaths. Ten women were followed up at our institution and at six months postpartum; 50% of these patients were still symptomatic.
Conclusion
We report favourable outcomes in 25 pregnant women with dilated cardiomyopathy who were managed by a multidisciplinary team.