Postural tachycardia syndrome complicating pregnancy

OBJECTIVE: To review clinical experience at our institution on postural tachycardia syndrome (POTS) complicating pregnancy. METHODS: In a retrospective review, we identified nine pregnancies in seven patients with POTS syndrome at our institution. RESULTS: Patients who did not require treatment for POTS before conception were less likely to have an exacerbation of symptoms or need reintroduction of treatment. Exacerbations of POTS during pregnancy are variable. Of our patients with exacerbations of symptoms, increases in the existing pharmacologic treatments, such as increasing beta-blocker dosage, was effective in palliation of symptoms. There were seven vaginal deliveries. Two patients delivered without neuraxial anesthesia; the other five deliveries were done using epidural anesthesia without associated complications. POTS does not seem to contribute to pregnancy-related complications. Importantly, there were no adverse intrapartum events attributable to POTS. CONCLUSIONS: Pregnant women with POTS may undergo safe regional anesthesia and vaginal delivery. This contradicts earlier reports in the literature recommending cesarean delivery.