Hereditary haemorrhagic telangiectasia in pregnancy: regional and general anaesthesia. (February 2018) - Crawford, M.
Highlights: Hereditary haemorrhagic telangiectasia in pregnancy carries significant risk. Multiple pulmonary arteriovenous malformations posed a major risk for bleeding. Careful planning and teamwork is essential in complex obstetric case management. Abstract: Hereditary haemorrhagic telangiectasia, also known as Osler–Weber–Rendu disease, is a rare autosomal dominant multisystem disorder, characterised by mucocutaneous telangiectases and arteriovenous malformations affecting any organ. The physiological changes in pregnancy pose significant obstetric and anaesthetic challenges for women affected by the disease. The optimal timing and mode of delivery requires careful consideration; and the benefits and risks of both regional and general anaesthetic techniques must be carefully considered, depending on the organs affected. This case report describes the successful management of a patient with this disease and severe pulmonary involvement, who received both regional and general anaesthesia as a result of a complication in the initial anaesthetic plan. The report demonstrates the benefits of a multidisciplinary approach to a complex case, achieved through providing care in a tertiary centre with appropriate expertise and resources.