Successful use of continuous veno-venous haemofiltration to treat profound fluid retention in severe peripartum cardiomyopathy

Anesthesia in pregnancy with heart disease

Management of pregnant women with heart disease remains challenging due to the advancement of innovations in cardiac surgery and correction of complex cardiac anomalies, and more recently, with the successful performance of heart transplants, cardiac diseases are not only likely to coexist with pregnancy, but will also increase in frequency over the years to come. In developing countries with a higher prevalence of rheumatic fever, cardiac disease may complicate as many as 5.9% of pregnancies with a high incidence of maternal death. Since many of these deaths occur during or immediately following parturition, heart disease is of special importance to the anesthesiologist. This importance arises from the fact that drugs used for preventing or relieving pain during labor and delivery exert a major influence - for better or for worse - on the prognosis of the mother and newborn. Properly administered anesthesia and analgesia can contribute to the reduction of maternal and neonatal mortality and morbidity.

Peripartum cardiomyopathy: a condition intensivists should be aware of

We use an illustrative case of severe peripartum cardiomyopathy with congestive heart failure to introduce this topic and proceed to cover its pathophysiology, incidence, management and outcome.

Critical care obstetrics and gynecology

The critical care aspects of obstetrics and pregnancy are varied and demand that critical care practitioners have a thorough knowledge of fetal and maternal changes in physiology as pregnancy progresses. Pregnancy can affect every organ system; and organ-specific conditions as well as syndromes that span multiple organ systems were described. Care of the critically ill, pregnant patient requires a true multidisciplinary approach for optimal outcomes. A review of the current concepts and suggestions for therapy were presented.

Management of the critically ill cardiac patient

The decline in rheumatic fever has made heart disease in pregnancy an uncommon problem in the developed world but it remains an important cause of maternal morbidity and mortality in developing countries. Pregnancy is particularly dangerous in the presence of cyanotic congenital heart disease, Eisenmenger's syndrome, primary pulmonary hypertension, Marfan's syndrome, dilated cardiomyopathy and significant mitral stenosis. Severe stenosis is often complicated by pulmonary hypertension and atrial fibrillation. Maternal disease status should be determined using echocardiography to define cardiac anatomy, assess ventricular function and estimate intracardiac pressure gradients. Patients in the New York Heart Association functional classes 1 and 2 generally have a favourable outcome. Closed mitral commissurotomy is safe and effective in relieving stenosis across the mitral valve in selected patients. More recently the technique of percutaneous balloon mitral valvotomy has successfully been used in the treatment of mitral stenosis. Termination of pregnancy is advised in patients with severe pulmonary hypertension, including Eisenmenger's syndrome.