Key result
Epidural analgesia and oxytocin induction allowed for a successful and hemodynamically stable vaginal delivery in a 29-year-old primigravid woman with severe aortic stenosis.
Why the study?
There is no consensus on absolute contraindications to vaginal delivery in valvular heart disease, and central regional anesthesia is traditionally considered contraindicated in severe aortic stenosis.
Case Report (n=1)
No
Epidural analgesia and oxytocin induction are feasible for labor management in parturients with severe aortic stenosis when supported by continuous hemodynamic monitoring.
May support monitored vaginal delivery with epidural/oxytocin in severe AS; leaves open generalizability pending prospective data.
BACKGROUND: A history of previous cardiac disease increases the maternal mortality risk by as much as 100%. There is no consensus on the absolute contraindications to vaginal delivery in valvular heart disease, but central regional anesthesia is traditionally considered contraindicated in patients with severe aortic stenosis. CASE PRESENTATION: A 29-year-old primigravid woman with severe aortic stenosis was admitted to the obstetrics department for programmed labor induction. With epidural anesthesia and mini-invasive hemodynamic monitoring labor and operative vaginal delivery were well tolerated, and hemodynamic stability was always maintained. CONCLUSIONS: Epidural analgesia and oxytocin induction are possible for the labor management of parturients with severe aortic stenosis given that continuous non-invasive followed by invasive hemodynamic monitoring can be provided and given the absence of any obstetric or cardiologic contraindications and the strong will of the patient.
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Driul et al. (2020) conducted a case report in Severe aortic stenosis in pregnancy (n=1). Epidural analgesia and oxytocin induction with hemodynamic monitoring was evaluated on Hemodynamic stability and successful vaginal delivery. Epidural analgesia and oxytocin induction allowed for a successful and hemodynamically stable vaginal delivery in a 29-year-old primigravid woman with severe aortic stenosis.
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