Anesthetic management of cesarean delivery of parturient with systemic lupus erythematosus associated with pulmonary arterial hypertension - A case report -

Abstract

Background: Pulmonary hypertension in pregnancy is rare and leads to high maternal morbidity and mortality.Case: A 27-year-old parturient woman with a 31-week gestational age underwent cesarean delivery under combined spinal-epidural anesthesia. She had systemic lupus erythematosus associated with severe pulmonary arterial hypertension. The operation was done in the cardiac theatre along with meticulous invasive monitoring. Insertion of femoral artery and femoral vein catheters for veno-arterial extracorporeal membrane oxygenation was done before delivery as preparation for the potential emergency of a life-threatening form of decompensated cardiac failure. During the delivery, the patient suddenly developed increased pulmonary arterial pressure. This was controlled by the continuous infusion of intravenous milrinone.Conclusions: We report the successful management of this patient in the perioperative period. For cases such as that reported here, we recommend multidisciplinary team collaboration coupled with invasive cardiovascular monitoring and scrupulous anesthetic management.

Cesarean Section in a Group 1 Pulmonary Hypertension Parturient Patient: A Case Report

“…Uterotonics, commonly used to promote uterine contraction after delivery to prevent postpartum hemorrhage, can decrease systemic vascular resistance and increase PVR, which can exacerbate cardiovascular collapse [ 18 , 19 ]. Among these agents, methylergonovine and carboprost are contraindicated in patients with PH because of their potential vasoconstrictive effects on pulmonary vasculatures [ 20 , 21 ]. Oxytocin and misoprostol are more acceptable choices for such patients, as their impact on pulmonary artery pressure is relatively low [ 21 ].…”

“…When oxytocin is administered in large concentrations or as a bolus dose, it can cause significant hypotension and tachycardia secondary to a decrease in systemic vascular resistance and venous return. Therefore, administering oxytocin via a slow infusion with continuous monitoring is recommended [ 10 , 20 , 22 ]. In this case report, the patient was given oxytocin in a low-dose infusion, which was gradually titrated under strict monitoring, including central venous pressures and PA pressures.…”