The Anesthetic Management of a Pre-Term Parturient Undergoing Urgent Cesarean Delivery for Fetal Complications within 30 Days of Drug-Eluting Stent Placement: A Case Report and Literature Review

Affiliation

¹Department of Anesthesiology and Perioperative Medicine, Obstetric Anesthesiology and Acute Pain Management, Rutgers New Jersey Medical School, Newark, NJ, USA
²Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA

Corresponding Author

Christy Anthony, MD, Department of Anesthesiology and Perioperative Medicine, Obstetric Anesthesiology, and Acute Pain Management. Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB E-538, Newark, NJ 07101-1709, USA, Tel: 973-972-0470; E-mail: christyanthony.ucla@gmail.com; secondary email: ca540@njms.rutgers.edu

Citation

Anthony, C., et al. The Anesthetic Management of a Pre-Term Parturient Undergoing Urgent Cesarean Delivery for Fetal Complications within 30 Days of Drug-Eluting Stent Placement: A Case Report and Literature Review. (2018) J Anesth Surg 5(1): 34- 38.

Abstract

Cardiomyopathy in pregnancy is a prevalent disease we encounter as obstetric anesthesiologists, and can be a major cause of maternal perinatal morbidity and mortality if not appropriately managed, particularly during the antepartum period[1]. The gold standard of care remains neuraxial anesthesia with adequate labor analgesia and vaginal delivery if feasible[2]. However, this technique is not always appropriate as women may present with contraindications to neuraxial anesthesia, such as women on anticoagulation. This is particularly noted in women who have known cardiac disease, as women who undergo coronary interventions prior to labor are managed with chemical anticoagulation. General anesthetic consideration for this population takes into account not only cardiac techniques but the implications on fetal wellbeing[2]. Although maternal outcomes remain our priority as the safety of the mother is necessary for fetal survival, improving fetal status at birth is ideal. In this particular paper, we discuss the challenges we faced in a parturient who underwent percutaneous coronary intervention during her pregnancy, and required urgent cesarean section within 30 days of receiving a drug-eluting stent. We present the literature surrounding these concerns and the options available to anesthesiologists to provide safe anesthesia for both mother and fetus.