Anaesthetic considerations in a parturient with critical coronary artery disease and a drug-eluting stent presenting for caesarean section

A national survey of obstetric anaesthesia guidelines in the UK

“…Such referrals may be helpful in conditions as diverse as drug dependency, 12 obesity 13 and heart disease. 14,15 Referral guidance may help clinics run efficiently, aid communication between anaesthetic and obstetric staff and provide an opportunity for patient education. 16 In 2005, a survey of UK obstetric units showed that only 30% of units ran a formal anaesthetic pre-assessment clinic with 70% relying on ad hoc referrals.…”

Coronary artery disease and myocardial infarction in pregnancy: A review of epidemiology, diagnosis, and medical and surgical management

“…Little is known about the safety of other antiplatelet agents in pregnancy including clopidogrel, ticlopidine and the platelet glycoprotein IIb/IIIa inhibitors. The limited published information consists of case reports describing the use of clopidogrel at as early as 18 weeks' gestation (20)(21)(22). Maternal hemorrhage requiring transfusion was required in one case; a positive fetal outcome was described in all three.…”

“…Percutaneous coronary intervention has been well documented during pregnancy, and is considered to be safe for maternal and fetal survival (20,(22)(23)(24)32). In most cases, percutaneous coronary intervention is preferred over thrombolysis due to the decreased risk of hemorrhage and the increased incidence of coronary dissection as a cause of myocardial infarction in the pregnant population.…”

6. Fármacos cardiovasculares na gestação e amamentação

“…Em gestantes, o parto é um período crítico, pelo risco aumentado de hemorragias. Em um relato de caso em que não houve a suspensão do clopidogrel num período de 7 a 10 dias antes do parto, a paciente, submetida a parto cesáreo, teve complicação com hemorragia intra-abdominal, necessitando de uma transfusão de sangue para estabilizar o quadro de oligúria e baixo débito 44 .…”