Abstract:
The significant improvement in the management of heart disease has resulted in more of
these patients reaching childbearing age. As the cardio-vascular demands of pregnancy are
further aggravated by labour, an anatomically mild or moderate lesion can become a
functionally severe life-threatening problem. In fact in the triennium 1991-93 in UK,
maternal deaths due to cardiac disease were the highest with 41 deaths, in comparison to
thromboembolism (35) and hypertensive disease (20) 1 . Thus these patients need highly
skilled medical intervention in intensive care units during the peripartum period. The
marked increases in pre-load, after-load and heart rate due to painful uterine contractions
and bearing down efforts could be minimized by epidural analgesia and anaesthesia which
allows forceps, vacuum or caesarean section delivery without pain and stress, and has been
advocated by many authors 2,3,4,5,6,7. However the risk of hypotension due to sympathetic
blockade in patients with already compromised cardiac output in considered by others as a
contraindication to epidural block 8. 100 parturient with heart disease admitted to the ICU,
DMH (over a period of 12 months) were studied retrospectively. On admission to the ICU
all patients were reassessed clinically to verify the diagnosis and identify complications. If
the diagnosis was in doubt or the patients had new complications they were referred to the
cardiologist for further evaluation and 2D echocardiography. Carefully controlled epidural
analgesia and anaesthesia by anaesthetists experienced in the technique is not only safe, but
beneficial, if the pathophysiology and cardio-vascular status of the patient is understood and
meticulous fluid management is practiced. It should be stressed that an experienced
obstetrician with good surgical skills is essential to produce good results
