oxytocin and Cardiomyopathy--Hypertrophic

Haemodynamic changes that occur during pregnancy are maximal between 28 and 34 weeks. In the pregnant woman with several associated diseases, such as hypertensive myocardiopathy and pre-gestational diabetes, these changes can lead to a difficult control of pulmonary hypertension and acute pulmonary oedema. We report the case of a pregnant woman with long term type 1 diabetes mellitus who suffered pre-eclampsia in a previous pregnancy, and since then developed hypertensive cardiomyopathy. She was admitted at 30 week gestation for metabolic and blood pressure control, and developed congestive cardiac failure after the administration of betamethasone for foetal lung maturity. A transthoracic echocardiogram showed a non-dilated hypertrophic left ventricle with good systolic function, restrictive diastolic dysfunction and moderate pulmonary arterial hypertension. When her general condition improved, we performed a caesarean section under regional anaesthesia to prevent the complications of pulmonary and systemic hypertension. We present the anaesthetic management and resolution of complications after oxytocin administration.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Betamethasone; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Cesarean Section, Repeat; Diabetes Mellitus, Type 1; Diastole; Female; Heart Failure; Humans; Hypertension, Pulmonary; Hypotension; Infant, Newborn; Intraoperative Complications; Norepinephrine; Oxytocin; Phenylephrine; Pre-Eclampsia; Preanesthetic Medication; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Supine Position

We report the case of a caesarean section under combined spinal and epidural anaesthesia in a pregnant 32-year-old woman with an hypertrophic obstructive cardiomyopathy. In these patients, variations of the ventricular load conditions may induce a cardiac inefficacy. In this context, the post-partum haemorrhage is a feared complication, prevent in part by oxytocine intravenously. However, its injection can be associated with haemodynamic instability, even at a low dose, and it does not spread post-partum haemorrhage. The arterial ligation according to the technique of Tsirulnikov is an alternative that we reported. This technique is followed by a good obstetrical prognosis.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Cardiomyopathy, Hypertrophic; Cesarean Section; Female; Hemodynamics; Humans; Ligation; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Ultrasonography; Uterine Artery

Topics: Adrenergic beta-Antagonists; Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthetics, Local; Blood Pressure; Bupivacaine; Cardiomyopathy, Hypertrophic; Cesarean Section; Ephedrine; Female; Heart Rate; Humans; Hypertension; Hypotension; Metoprolol; Myocardial Infarction; Oxytocics; Oxytocin; Postoperative Complications; Postpartum Period; Tachycardia; Vasoconstrictor Agents

Topics: Adult; Cardiomyopathy, Hypertrophic; Catheterization, Swan-Ganz; Female; Humans; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome

Topics: Adult; Cardiomyopathy, Hypertrophic; Dinoprostone; Female; Humans; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Pulmonary Edema