PMID- 20194011
OWN - NLM
STAT- MEDLINE
DCOM- 20101202
LR  - 20100712
IS  - 1532-3374 (Electronic)
IS  - 0959-289X (Linking)
VI  - 19
IP  - 3
DP  - 2010 Jul
TI  - Anesthetic management of a consecutive cohort of women with heart disease for 
      labor and delivery.
PG  - 266-72
LID - 10.1016/j.ijoa.2009.09.006 [doi]
AB  - BACKGROUND: The cardiovascular changes of pregnancy may place additional stress 
      upon women with pre-existing heart disease, increasing peripartum morbidity and 
      mortality. The purpose of this descriptive study was to report the anesthetic 
      management of a large cohort of pregnant women with heart disease. METHODS: The 
      medical records of 522 consecutive parturients (657 pregnancies) with heart 
      disease who delivered at Toronto General Hospital or Mount Sinai Hospital in 
      Toronto, Ontario, Canada between 1986 and 2004 were reviewed. Obstetric, medical 
      and anesthetic management data were collected and the women were stratified by 
      New York Heart Association (NYHA) functional status at delivery. The main outcome 
      of interest was the method of analgesia or anesthesia administered during labor 
      and delivery. Univariate and multivariate analysis was performed to identify risk 
      factors associated with the administration of general anesthesia. RESULTS: Of 657 
      pregnant women, 602 were NYHA 1/2 and 55 were NYHA 3/4 at time of delivery. 
      Epidural analgesia was administered to 84% of NYH 1/2 women and 83% of NYH 3/4. 
      The cesarean section rates were 29% and 31% respectively. The rate of general 
      anesthesia for the entire cohort was 9%. Factors associated with the use of 
      general anesthesia for operative delivery included cesarean delivery (adjusted 
      O.R. 74; 95% CI 9.5, 573), delivering at Toronto General Hospital site (adjusted 
      O.R. 5.5; 95% CI 2.3, 13.3), presence of complex congenital heart lesion 
      (adjusted O.R. 2.3; 95% CI 1.0, 5.4) and each week of premature delivery 
      (adjusted O.R. 1.3; 95% CI 1.1, 1.5). Three percent suffered intrapartum cardiac 
      complications; there was one death. CONCLUSIONS: Pregnant women with heart 
      disease managed within an organized program may undergo labor and delivery with 
      acceptable rates of complications. Cesarean section, epidural 
      analgesia/anesthesia and general anesthesia rates are similar to those in the 
      general obstetric population.
CI  - 2009 Elsevier Ltd. All rights reserved.
FAU - Goldszmidt, E
AU  - Goldszmidt E
AD  - Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, 
      Ontario, Canada. e.goldszmidt@utoronto.ca
FAU - Macarthur, A
AU  - Macarthur A
FAU - Silversides, C
AU  - Silversides C
FAU - Colman, J
AU  - Colman J
FAU - Sermer, M
AU  - Sermer M
FAU - Siu, S
AU  - Siu S
LA  - eng
GR  - 53150/Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100302
PL  - Netherlands
TA  - Int J Obstet Anesth
JT  - International journal of obstetric anesthesia
JID - 9200430
SB  - IM
MH  - Adult
MH  - *Anesthesia, Epidural
MH  - *Anesthesia, General
MH  - *Anesthesia, Obstetrical
MH  - Cesarean Section
MH  - Cohort Studies
MH  - Delivery, Obstetric
MH  - Female
MH  - Fetal Distress/complications
MH  - Gestational Age
MH  - Humans
MH  - Labor Presentation
MH  - Labor, Obstetric/physiology
MH  - Monitoring, Intraoperative
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/mortality/*therapy
MH  - Risk Factors
MH  - Treatment Outcome
EDAT- 2010/03/03 06:00
MHDA- 2010/12/14 06:00
CRDT- 2010/03/03 06:00
PHST- 2009/01/16 00:00 [received]
PHST- 2009/05/22 00:00 [revised]
PHST- 2009/09/22 00:00 [accepted]
PHST- 2010/03/03 06:00 [entrez]
PHST- 2010/03/03 06:00 [pubmed]
PHST- 2010/12/14 06:00 [medline]
AID - S0959-289X(09)00186-1 [pii]
AID - 10.1016/j.ijoa.2009.09.006 [doi]
PST - ppublish
SO  - Int J Obstet Anesth. 2010 Jul;19(3):266-72. doi: 10.1016/j.ijoa.2009.09.006. Epub 
      2010 Mar 2.