Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE S3 ( December, 2021 ) > List of Articles

INVITED ARTICLE

Critical Care Management of the Parturient with Cardiac Disease

Uma R Hariharan, Indira Malik

Keywords : Arrhythmias, Cardiac failure, Cardiac risk assessment, Cardiomyopathies, Congenital cardiac lesions, Critical care, Ischemic heart disease, Parturient, Pericarditis, Pulmonary hypertension, Valvular heart disease

Citation Information :

DOI: 10.5005/jp-journals-10071-24068

License: CC BY-NC 4.0

Published Online: 12-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Parturient with heart disease forms a challenging group of patients and requires specialized critical care support in the peripartum period. Maternal heart disease may remain undiagnosed till the second trimester of pregnancy, presenting frequently after 20 weeks of gestation, due to increased demands imposed on the cardiovascular system and pose a serious risk to the life of mother and fetus. Management of critically ill parturient with heart disease must be tailored according to individual assessment of the patient and requires a strategic, multidisciplinary, and protocol-based approach. A dedicated obstetric intensive care unit (ICU) and team effort are the need of the hour.


PDF Share
  1. Huisman CM, Zwart JJ, Roos-Hesselink JW, Duvekot JJ, van Roosmalen J. Incidence and predictors of maternal cardiovascular mortality and severe morbidity in the Netherlands: a prospective cohort study. PLoS One 2013;8(2):e56494. DOI: 10.1371/journal.pone.0056494.
  2. Hu H, Pasca I. Management of complex cardiac issues in the pregnant patient. Crit Care Clin 2016;32(1):97–107. DOI: 10.1016/j.ccc.2015.08.004.
  3. Karnad GR, Guntupalli KK. Critical illness and pregnancy: review of a global problem. Crit Care Clin 2004;20(4):555–576. DOI: 10.1016/j.ccc.2004.05.001.
  4. Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol 2013;27(6):791–802. DOI: 10.1016/j.bpobgyn.2013.08.001.
  5. Carbillion L, Uzan M, Uzan S. Pregnancy, vascular tone and maternal hemodynamics: a crucial adaptation. Obstet Gynecol Surv 2000;55(9):574–581. DOI: 10.1097/00006254-200009000-00023.
  6. Moghbeli N, Pare E, Webb G. Practical assessment of maternal cardiovascular risk in pregnancy. Congenit Heart Dis 2008;3:308-16.
  7. Vasu S, Stergiopoulus K. Valvular heart disease in pregnancy. Hellenic J Cardiol 2009;50(6):498–510. PMID: 19942564.
  8. Ortman AJ. The pregnant patient with congenital heart disease. Semin Cardiothorac Vasc Anesth 2012;16(4):220–234. DOI: 10.1177/1089253212445056.
  9. Obican SG, Cleary KL. Pulmonary arterial hypertension in pregnancy. Semin Perinatol 2014;38(5):289–294. DOI: 10.1053/j.semperi.2014.04.018.
  10. James AH, Jamison MG, Biswas MS. Acute myocardial infarction in pregnancy: a United States population –based study. Circulation 2006;113(12):1564–1571. DOI: 10.1161/CIRCULATIONAHA.105.57 6751.
  11. Burt CC, Durbridge J. Management of cardiac disease in pregnancy. Contin. Edu Anaesth Critic Care Pain 2009;9(2):44-48. DOI: 10.1093/bjaceaccp/mkp005.
  12. Trikha A, Singh PM. The critically ill obstetric patient – recent concepts. Indian J Anaesth 2010;54(5):421–427. DOI: 10.4103/0019-5049.71041.
  13. Cauldwell M. Pregnancy in the woman with cardiovascular disease- congenital and acquired. In: Lowe S, editor. The continuous textbook of women's medicine–obstetric module, vol. 8. 2021.
  14. Weiner MM, Hamburger J, Beilin Y. The pregnant patient with cardiac disease. In: Kaplan JA, editor. Kaplan's cardiac anesthesia. 7th ed. Phildelphia: Elsevier; 2011.
  15. Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. ZAHARA Investigators. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007;49(24):2303–2311. DOI: 10.1016/j.jacc.2007.03.027.
  16. Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multi-center study of pregnancy outcomes in women with heart disease. Circulation 2001;104(5):515–521. DOI: 10.1161/hc3001.093437.
  17. Bloria SD, Bajaj R, Luthra R, Chauhan R. Managing heart disease in pregnancy. EMJ 2020;5(1):58–66. DOI/10.33590/emj/19-00131.
  18. Catanzarite V, Willms D, Wong D, Landers C, Cousins L, Schrimmer D. Acute respiratory distress syndrome in pregnancy and the puerperium: causes, courses and outcomes. Obstet Gynecol 2001;97:760–764. DOI: 10.1016/s0029-7844(00)01231-x.
  19. Lapinsky SE, Posadas-Calleja JG, McCullagh I. Clinical review: ventilatory strategies for obstetric, brain injured and obese patients. Crit Care 2009;13(2):206. DOI: 10.1186/cc7146.
  20. Lucas DN, Robinson PN, Nel MR. Sepsis in obstetrics and the role of the anesthetist. Int J Obstet Anesth 2012;21(1):56–67. DOI: 10.1016/j.ijoa.2011.11.001.
  21. Pandya ST, Mangalampally K. Critical care in obstetrics. Indian J Anaesth 2018;62(9):724–733. DOI: 10.4103/ija.IJA_577_18.
  22. Mackintosh N, Watson K, Rance S, Sandall J. Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study. BMJ Qual Saf 2014;23(1):26–34. DOI: 10.1136/bmjqs-2012-001781.
  23. Albright CM, Ali TN, Lopes V, Rouse DJ, Anderson BL. The sepsis in obstetrics score: a model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol 2014;211(1):39e1–39e8. DOI: 10.1016/j.ajog.2014.03.010.
  24. Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med 2018;44(6):925–928. DOI: 10.1007/s00134-018-5085-0.
  25. Kaur M, Singh PM, Trikha A. Management of critically ill obstetric patients: a review. J Obstet Anaesth Crit Care 2017;7(1):3–12. DOI: 10.4103/joacc.JOACC_21_17.
  26. Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, Khoos BJ, et al. Management of pregnancy in patients with complex congenital heart disease: AHA scientific statement. Circulation 2017;135(8):e50–e87. DOI: 10.1161/CIR.0000000000000458.
  27. Tamhane P, O'sullivan G, Reynolds F. Oxytocin in parturients with cardiac disease. Int J Obstet Anesth 2008;17:46–52. DOI: 10.1016/j.ijoa.2006.04.006.
  28. Luthra A, Bajaj R, Jafra A, Jangra K, Arya VK. Anesthesia in pregnancy with heart disease. Saudi J Anaesth 2017;11(4):454–471. DOI: 10.4103/sja.SJA_277_17.
  29. van Hagen IM, Roos-Hesselink JW, Ruys TPE, Merz WM, Goland S, Gabriel H, et al. Pregnancy in women with a Mechanical Heart Valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation 2015;132(2):132–142. DOI: 10.1161/CIRCULATIONAHA.115.015242.
  30. Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation 1971;44(5):964–968. DOI: 10.1161/01.cir.44.5.964.
  31. Johnson-Coyle L, Jensen L, Sobey A. Peripartum cardiomyopathy: review and practice guidelines. Am J Crit Care 2012;21(2):89–98. DOI: 10.4037/ajcc2012163.
  32. Modi KA, Illum S, Jariatul K. Poor outcome of indigent patients with peripartum cardiomyopathy in the United States. Am J Obstet Gynecol 2009;201(2):e1–e5. DOI: 10.1016/j.ajog.2009.04.037.
  33. Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mabazaa A, Pieske B, Buchmann E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Eur J Heart Fail 2010;12(8):767–778. DOI: 10.1093/eurjhf/hfq120.
  34. Fox JF, Smith MM, Nuttall GA, Oliver WC. Uncommon cardiac diseases. In: Kaplan JA, editor. Kaplan's cardiac anesthesia. 7th ed. Phildelphia: Elsevier; 2011.
  35. Baum VC, DeSouza DG. Congenital heart disease in adults. In: Kaplan JA, editor. Kaplan's cardiac anesthesia. 7th ed. Phildelphia: Elsevier; 2011.
  36. Greutmann M, Pieper PG. Pregnancy in women with congenital heart disease. Eur Heart J 2015;36(37):2491–2499. DOI: 10.1093/eurheartj/ehv288.
  37. Pieper PG, Lameijer H, Hoendermis ES. Pregnancy and pulmonary hypertension. Best Pract Res Clin Obstet Gynaecol 2014;28(4): 579–591. DOI: 10.1016/j.bpobgyn.2014.03.003.
  38. Stoelting RK, Hines RL, Marschall KE, editors. Chapter 26: Pregnancy-associated diseases. Stoelting's anesthesia and co-existing disease. 6th ed. Philadelphia: Saunders; 2012. p. 559.
  39. Smith RL, Young SJ, Greer IA. The parturient with coronary heart disease. Int J Obstet Anesth 2008;17(1):46–52. DOI: 10.1016/j.ijoa.2007.04.006.
  40. Burkart TA, Conti JB. Cardiac arrhythmias during pregnancy. Curr Treat Options Cardiovasc Med 2010;12(5):457–471. DOI: 10.1007/s11936-010-0084-7.
  41. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstrom-Lundqvist C, Cifkova R, De Bonis M, et al. 2018 ESC guidelines on the management of cardiovascular diseases during pregnancy: the task Force for the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2018;39(34):3165–3241. DOI: 10.1093/eurheartj/ehy340.
  42. Franklin WJ, Rokey R, Foley MR, Belfort MA. Cardiac disease in pregnancy. In: Phelan JP, Luis DP, Foley MR, Saade GR, Dildy GA, Belfort MA, editors. Critical care obstetrics. 6th ed. John Wiley & Sons Ltd; 2019.
  43. Sharma NS, Wille KM, Bellot SC, Diaz-Guzman E. Modern use of extra-corporeal life support in pregnancy and postpartum. ASAIO J 2015;61(1):110–114. DOI: 10.1097/MAT.0000000000000154.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.