Combined Spinal-Epidural for Vaginal Delivery in a Parturient With Takayasu's Arteritis. (December 2016)

• Record Type: Journal Article
• Authors: Clifford, Sean Patrick; Mick, Paul Brian; Derhake, Brian Matthew
• Is Part Of: Journal of investigative medicine high impact case reports. Volume 4:Number 4(2016)
• Publication Date: 2016-12
• Subjects: Takayasu's arteritis -- combined spinal-epidural -- labor pain; Internal medicine -- Periodicals; Medical care -- Periodicals; 616.005
• DOI: 10.1177/2324709616683725
• Languages: English
• ISSNs: 2324-7096

Abstract

Takayasu's arteritis is a rare, progressive panendarteritis involving all layers of the arterial wall. This disease includes variable involvement of the aorta and its major branches. The most common complication with this condition is severe, uncontrolled hypertension, often leading to end organ dysfunction. We describe the management of a 27-year-old woman diagnosed with Takayasu's arteritis that presented in labor with intense pain and underwent a combined spinal-epidural for anesthetic management. Per literature review, a combined spinal-epidural technique for planned vaginal delivery has not been described for a laboring Takayasu patient. Our technique, utilizing intrathecal opioids and a low-dose local anesthetic-opioid epidural infusion, provided adequate analgesia while maintaining hemodynamic stability throughout labor augmentation and successful vaginal delivery.