Key result
Combined spinal-epidural anesthesia, invasive monitoring, and intravenous milrinone allowed for the successful cesarean delivery of a parturient with systemic lupus erythematosus and severe pulmonary arterial hypertension.
Why the study?
Pulmonary hypertension in pregnancy is rare and leads to high maternal morbidity and mortality.
Case Report (n=1)
No
Multidisciplinary management with invasive monitoring, combined spinal-epidural anesthesia, and intravenous milrinone can successfully manage cesarean delivery in parturients with severe pulmonary arterial hypertension secondary to systemic lupus erythematosus.
Supports feasibility of CSE anesthesia plus milrinone in severe PAH cesarean; hypothesis-generating and should not yet change practice.
BACKGROUND: Pulmonary hypertension in pregnancy is rare and leads to high maternal morbidity and mortality. CASE: A 27-year-old parturient woman with a 31-week gestational age underwent cesarean delivery under combined spinal-epidural anesthesia. She had systemic lupus erythematosus associated with severe pulmonary arterial hypertension. The operation was done in the cardiac theatre along with meticulous invasive monitoring. Insertion of femoral artery and femoral vein catheters for veno-arterial extracorporeal membrane oxygenation was done before delivery as preparation for the potential emergency of a life-threatening form of decompensated cardiac failure. During the delivery, the patient suddenly developed increased pulmonary arterial pressure. This was controlled by the continuous infusion of intravenous milrinone. CONCLUSIONS: We report the successful management of this patient in the perioperative period. For cases such as that reported here, we recommend multidisciplinary team collaboration coupled with invasive cardiovascular monitoring and scrupulous anesthetic management.
No takes yet. Share an insight, caveat, or question.
A 2022 study conducted a case report in Systemic lupus erythematosus associated with pulmonary arterial hypertension in pregnancy (n=1). Combined spinal-epidural anesthesia and multidisciplinary management was evaluated on Maternal and fetal survival and hemodynamic stability. Combined spinal-epidural anesthesia, invasive monitoring, and intravenous milrinone allowed for the successful cesarean delivery of a parturient with systemic lupus erythematosus and severe pulmonary arterial hypertension.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: