Anesthetic management for the peripartum care of women with Fontan physiology. (November 2021)

• Record Type: Journal Article
• Authors: McCabe, M.; An, N.; Aboulhosn, J.; Schwarzenberger, J.; Canobbio, M.; Vallera, C.; Hong, R.
• Is Part Of: International journal of obstetric anesthesia. Volume 48(2021)
• Publication Date: 2021-11
• Subjects: Arterial line -- Central line -- Congenital heart disease -- Fontan -- Intensive Care Unit; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2021.103210
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Patients with Fontan physiology are presenting for peripartum care at higher rates. Peripartum care should include multidisciplinary collaboration. Care should be individualized based on clinical status and physiologic reserve. Admission to the intensive care unit for peripartum care is not routine. Arterial and central venous lines can be reserved for physiologic decompensation. Abstract: Background: As outcomes for surgical palliation have improved, women with single ventricle congenital heart disease are surviving into their reproductive years and may become pregnant. The cardiovascular changes of pregnancy may stress the Fontan circulation and pose significant risk to the mother and fetus. Methods: Pregnant women with Fontan physiology were identified from the Ahmanson/UCLA Adult Congenital Heart Disease Center database. A total of 37 pregnancies were identified between 2000 and 2019. Twenty live births from 19 patients were reviewed and compared for cardiac history, obstetric history, anesthetic management and cardiovascular outcomes. Results: Median gestational age at delivery was 35 weeks. Ten of 20 births were by cesarean delivery. An epidural technique was used as the primary anesthetic for 19 deliveries and general anesthesia was used for one cesarean delivery. An arterial line was placed in the peripartum period for three deliveries. Central venous access was established in the peripartum period for one patient. The mean blood loss for cesarean deliveries was 626 mL (range 240–1200 mL). The mean net peri-operative intake/output was positive 93.5 mL. Three patients were briefly transferred to the intensive care unit postpartum for higher level monitoring and care. Conclusion: Epidural anesthesia is safe and effective for both vaginal and cesarean deliveries. Judicious fluid management is critical in minimizing postpartum cardiovascular complications. Many patients do not require a higher level of care, invasive monitoring or central venous access during the peripartum period.