Anesthetic management of labor in a patient with dextrocardia, congenitally corrected transposition, Wolff-Parkinson-White syndrome, and congestive heart failure

Article Abstract:

During a normal pregnancy the amount of blood pumped out of the heart, its cardiac output, is increased by 30 percent in the beginning of a pregnancy and by 40 percent during the last three months. The stress of labor contractions causes an increase in the amount of blood ejected from the ventricle of the heart at each heart beat, the stroke volume. Additional sources of stress exerted on the heart come after delivery, when the blood from the uterus reenters the maternal circulation. Catecholamines, chemicals produced by the body that excite the heart, are secreted in response to the pain of labor. Although all these changes are tolerated well in healthy patients, there can be problems in pregnant women with heart disease. A 29-year-old pregnant woman with a congenital heart disease had difficulty breathing, rapid heart beats and a dry cough. At the onset of labor, intensive heart monitoring was begun. The mode of delivery and type of anesthesia were carefully decided. Medications included nitroglycerine and furosemide to decrease the volume of blood fluid and to decrease the workload exerted on the heart. Although the patient was prepared for a cesarean section, vaginal delivery under epidural (spinal) local anesthesia was successful. The epidural anesthesia reduced the pain of labor, thereby limiting the amount of catecholamines produced while producing beneficial effects on the blood vessels themselves. This control of cardiac output did not affect the blood flow through the placenta to the fetus. The use of spinal epidural anesthesia offered cardiac stability in a pregnancy complicated by cardiac disease.

Dosage and administration, Anesthesia in obstetrics, Obstetrical anesthesia, Heart diseases in pregnancy

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Steroid-responsive nephrotic syndrome with renal insufficiency in the first trimester of pregnancy

Article Abstract:

The case report is presented of a 22-year-old pregnant woman who developed leg edema (swelling) at 18 weeks' gestation and flu-like symptoms. The patient previously had nephrotic syndrome (a kidney disorder in which excess protein and other substances enter the urine) for several years, which was treated with prednisone (a steroid drug). After laboratory tests were completed, the diagnosis of renal insufficiency due to minimal change nephropathy, a common cause of nephrotic syndrome, was made. Treatment with prednisone was started and the urinary protein level became normal. The patient's edema decreased and an apparently unaffected infant was delivered after 35 weeks' gestation. Acute renal failure during pregnancy is best diagnosed with the aid of urinalysis. In this case, excess protein in the urine led to the diagnosis of nephrotic syndrome. Nephrotic syndrome can be a relatively harmless condition, or a symptom of systemic disease such as systemic lupus erythematosus, diabetes mellitus, or preeclampsia (a condition of pregnancy associated with high blood pressure that can become very serious). Consideration of this patient's history helped establish the diagnosis and obviated the need for a kidney biopsy, the only definitive way to establish the diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Kidney diseases, Nephrotic syndrome, Kidney diseases in pregnancy

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Fetuses with congenital heart disease demonstrate signs of decreased cerebral impedance

Article Abstract:

The middle cerebral artery (MCA) Doppler ultrasound is used as a surrogate measurement to determine whether fetuses with congenital heart diseases (CHDs) exhibit any abnormal changes in cerebrovascular impedance. The fetuses with CHDs are more likely to have decreased cerebrovascular impedance, thereby representing a marker to cerebral hypoxemia that is due to intracardiac mixing of oxygenated and deoxygenated blood.

Usage, Doppler ultrasonography, Clinical report

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