Department of Anesthesiology, National Cerebral and Cardiovascular Center Hospital, Suita, Japan.
Medicine (Baltimore). 2023 Mar 17;102(11):e33277. doi: 10.1097/MD.0000000000033277.
Emergency cesarean delivery in patients with heart failure increases maternal and fetal mortality. The present study aimed to identify the relationship between the use of anesthesia for delivery and progressive cardiac deterioration in women with dilated cardiomyopathy (DCM) and to examine its implications on maternal and fetal outcomes. Twenty-nine pregnancies in 25 women with DCM from the National Cerebral and Cardiovascular Center Hospital (Suita, Japan) were included in this retrospective longitudinal study. Fourteen of the patients (48.3%) delivered via cesarean section. Among these, 4 patients (13.8%) experienced heart failure within 42 days of delivery. The indication for cesarean delivery was heart failure in 3 patients and induction failure in 1 patient. The types of anesthesia used for these patients included general (n = 1), combined spinal-epidural (n = 2), and epidural (n = 1). Two of these cesarean deliveries were performed preterm. The left ventricular ejection fraction of patients with heart failure was ≤ 35% before 34 weeks gestation. Among the 25 patients without heart failure, 2 exhibited a left ventricular ejection fraction of ≤ 35% before 34 weeks gestation. Meanwhile, the types of anesthesia used for remaining 10 patients who did not experience heart failure included general (n = 1), combined spinal-epidural (n = 8), and epidural (n = 1). The rate of general anesthesia was 25% in patients who experienced heart failure and 4% in others. There was no incidence of maternal or fetal death. A preterm anesthetic evaluation may be warranted to optimize anesthetic management when the ejection fraction decreases to ≤ 35% before 34 weeks gestation in patients with DCM.
心力衰竭产妇行急诊剖宫产会增加母婴死亡率。本研究旨在明确麻醉分娩与扩张型心肌病（DCM）女性进行性心脏恶化之间的关系，并探讨其对母婴结局的影响。本回顾性纵向研究纳入了来自日本国立循环器病研究中心医院（大阪府吹田市）的 25 名 DCM 女性的 29 例妊娠。其中 14 例（48.3%）行剖宫产分娩。在这些患者中，有 4 例（13.8%）在分娩后 42 天内发生心力衰竭。行剖宫产的指征分别为心力衰竭 3 例和引产失败 1 例。用于这些患者的麻醉类型包括全身麻醉（n=1）、腰硬联合麻醉（n=2）和硬膜外麻醉（n=1）。其中 2 例剖宫产分娩为早产。发生心力衰竭的患者在 34 孕周前左心室射血分数（LVEF）≤35%。在 25 名无心力衰竭的患者中，有 2 例在 34 孕周前 LVEF≤35%。而其余 10 例未发生心力衰竭的患者使用的麻醉类型包括全身麻醉（n=1）、腰硬联合麻醉（n=8）和硬膜外麻醉（n=1）。发生心力衰竭的患者全身麻醉率为 25%，而无心力衰竭的患者为 4%。母婴均未死亡。对于 DCM 患者，当 LVEF 在 34 孕周前降至≤35%时，可能需要进行早产麻醉评估，以优化麻醉管理。
