Emergency LSCS for moderate to severe mitral stenosis in pregnancy- A comparision between graded epidural vs general

Mitral stenosis is the most common heart disease associated with pregnancy in developing countries like India in spite of the decrease prevalence of rheumatic heart disease. majority of deaths occur during labour or in the peripartum period due to unique physiological change in pregnancy in a fixed cardiac output state. 50 parturients with moderate to severe mitral stenosis under-going caeserean section were devided into two groups of 25 each. one group received general anaesthesia and the other group received graded epidural. It was found that both the groups maintained the vitals quiet well. But the was a higher incidence of pulmonary oedema in general anaesthesia group (9out of 25) as compared to graded epidural group (3 out of 25) and hence the duration of ICU stay was prolonged in general anaesthesia group. The fetal outcome was also better in graded epidural group as compared to the general anaesthesia group (APGAR score was high in graded epidural group, P value≤0.001).