Epidural anaesthesia during labour for a patient with congenital complete heart block: a case report.

Abstract

We report labour pain management in a full-term pregnant patient with Congenital Complete Heart Block. She delivered uneventfully under routine monitoring with facilities for pacing at hand. She previously had an uneventful normal delivery and a D&E, both outside our hospital. Only findings were a low heart rate of 45-50 beats per minute. She never had syncopal attacks. She had a good effort tolerance on ETT. Her ejection fraction was 60% on Echocardiogram. She was given a single shot low dose spinal with fentanyl followed by epidural insertion. She successfully delivered through mid-cavity forceps in about 2.5 hours. The only problem encountered was a transient bradycardia of 40 per minute with a systolic blood pressure of 70 mmHg, which settled with ephedrine. Pace maker insertion is recommended early in case the patient is symptomatic or has a prolonged Q-T interval or left atrial enlargement on ECG. Regional anaesthesia is recommended to prevent valsalva induced bradycardia or cardiac arrest during expulsive efforts by the patient.

• Authors: Abdul Monem, Ursula Chohan, Mohammed Ali
• Journal: JPMA. The Journal of the Pakistan Medical Association (J Pak Med Assoc) Vol. 57 Issue 11 Pg. 565-6 (Nov 2007) ISSN: 0030-9982 [Print] Pakistan
• PMID: 18062525 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Anesthesia, Epidural
• Atrioventricular Block (etiology, physiopathology)
• Cardiac Output
• Female
• Heart Defects, Congenital (complications)
• Humans
• Labor Pain (drug therapy)
• Pregnancy