Managing cardiovascular disease during pregnancy: best practice to optimize outcomes

Association of hemodynamics during caesarean section, outcomes after caesarean section and hormone changes with different anesthesia in pregnant women with severe pulmonary arterial hypertension

In the present study we aimed to analyze the effects of different anesthesia methods on the hemodynamics of caesarean section, outcomes after caesarean section and hormone changes in pregnancy complicated with severe pulmonary arterial hypertension (PAH). A total of 75 pregnancy complicated with severe PAH that were treated in Jining First People's Hospital from January 2016 to January 2017 were selected. Three groups were set according to the anesthesia methods, including the subarachnoid combined epidural anesthesia group (group I, n=25), the epidural anesthesia group (group II, n=25) and the general anesthesia group (group III, n=25). Effects on the outcomes of caesarean section of pregnancy complicated with PAH were observed. Sex hormone levels before and 24, 48 and 72 h after the operation were measured. There were remarkable changes in the postoperative hemodynamics compared with those before anesthesia, but changes in groups I and II were significantly smaller than those in group III (P<0.05). No significant differences in maternal mortality rate, neonatal mortality rate and neonatal asphyxia rate among the three groups were found (P>0.05). Time of postoperative mechanical ventilation, ICU residence and hospitalization in groups I and II were shorter than those in group III, the differences were statistically significant (P<0.05). Postoperative levels of sex hormones, including estradiol (E2), human chorionic gonadotrophin (HCG), prolactin (PRL) and plasma total testosterone (TT) decreased, while postoperative levels of sex hormones follicle stimulating hormone (FSH), luteinizing hormone (LH) and progestogen increased, and differences in the decreased E2 and TT at each time-point were statistically significant (P<0.05). In conclusion, there is no remarkable difference in the effects of three anesthesia methods on pregnancy outcomes. However, compared with general anesthesia, intravertebral anesthesia achieve shorter time of postoperative mechanical ventilation, ICU residence and hospitalization in pregnancy complicated with severe PAH, which is preferred in pregnancy without contraindication of the anesthesia.

Successful management of fatal peripartum cardiomyopathy in a young pregnant woman: A case report

RATIONALE

Peripartum cardiomyopathy (PPCM) is a rare and life-threatening form of pregnancy associated myocardial disease.

PATIENT CONCERNS

In the present report, we describe a case of a patient with PPCM at 33 weeks of gestation with stillbirth and cardiorespiratory failure.

DIAGNOSES

Peripartum cardiomyopathy.

INTERVENTIONS

The patient underwent emergency cesarean section (CS) and comprehensive medical treatments, including bromocriptine, as well as positive inotropic agents and diuretics after the CS.

OUTCOMES

She had an uneventful recovery period, and was discharged 9 days after surgery. Her heart function was restored within 6 months after CS, and follow-up echocardiographies indicated normal heart function.

LESSONS

This case highlights that early diagnosis and timely termination of pregnancy are crucial in the management of PPCM.

Qualidade de vida de cardiopatas durante a gestação e após o parto

Resumo Objetivo Analisar as mudanças na qualidade de vida em pacientes cardiopatas durante a gestação e após o parto, e estudar as correlações das características sociodemográficas e clínicas com medidas de qualidade de vida no puerpério. Métodos Estudo prospectivo que incluiu 33 gestantes selecionadas por amostra não probabilística. O instrumento de pesquisa foi o questionário SF-36. Para a comparação das médias dos escores dos domínios do SF-36 foi utilizado o test t de Student e o coeficiente de Spearman para possíveis correlações. Resultados Comparada à gestação, houve melhora na avaliação de qualidade de vida após o parto, exceto nos domínios estado geral de saúde e vitalidade. A variável planejamento da gestação indicou correlação positiva com o domínio saúde mental e negativa com aspectos emocionais no puerpério. Conclusão Após o parto houve melhora na qualidade de vida. Não planejar a gestação contribuiu melhorou a saúde mental, mas agravou os aspectos emocionais no puerpério.