Abreu LA, Madruga B, Gouvea J, Zapata Z and Bersot CD
Pregnant patients with Congenital heart disease (CHD) make for a unique challenge to the obstetrician and anesthesiologist, when the patient has to undergo emergency cesarean section. Managing high-risk parturient requires a thorough understanding of the hemodynamic changes of pregnancy, its effect on the patient and physiology of the abnormal heart. Beyond this, our patient presented with placenta previa and vaginal bleeding. This combination of factors makes this case a worst-case scenario for any anesthesiologist. There is limited data in the literature on these combination factors. CHD is becoming the most common source of cardiac problems in pregnant patients but non-corrected cardiac defect patient are rare cases in the obstetric department. In adult population, chronic non-palliated congenital heart lesions present new difficult situations for the anesthesiologist working with high-risk obstetric anesthesia. This case report makes a successful cesarean section in a CHD patient in emergency condition. A 27 year old female from Rio de Janeiro, Brazil; Gravida 1, Para 0, at 30 weeks gestation age was admitted to Pedro Ernesto University Hospital (HUPE) high risk maternity ward in Rio de Janeiro, she had a history of endocarditis in 2005. The patient was diagnosed with a complete placenta previa and was admitted to have a scheduled cesarean section. At 31 weeks of gestation the patient presented vaginal bleeding, the probable diagnosis was of placenta previa bleeding and emergency cesarean section was indicated. The anesthesia technique was general anesthesia with inhaled and intravenous anesthetic agents in rapid sequence induction. The newborn was delivered quickly with APGAR score 8 after 5 minutes. Postoperatively, the patient was admitted to the intensive care unit (ICU) for close monitoring of vital signs and post-operative care. The case report will include details in pre-operative, peri-operative and post-operative outcome of the patient.