Implications for anesthetic care in antenatal and postpartum care for pregnant women with cardiovascular conditions

Abstract

Cardiovascular disease (CVD) has become an increasingly prevalent cause of maternal morbidity and mortality during pregnancy over the past decade. This trend emerges due to rising survival rates in patients with congenital heart disease, but also due to an increased prevalence of acquired conditions such as arterial hypertension. The physiological changes of pregnancy, such as the 40–50% increase in cardiac output and a reduction in systemic vascular resistance in particular, pose significant risks to women with impaired cardiac function. Effective management requires an interdisciplinary Pregnancy Heart Team (PHT), of which anaesthetists are an integral part. Preconception and antenatal anaesthetic assessments are crucial for planning labour analgesia or surgical deliveries, particularly in high-risk cases. The use of regional anaesthetic techniques is generally preferred, although general anaesthesia may be required in emergency situations or when neuraxial blocks are contraindicated. Specialist anaesthetists should be involved in caring for women at risk of acute decompensation or requiring advanced support. It is vital to carefully select anaesthetic agents, as drugs such as methylergometrine, oxytocine and carboprost can exacerbate cardiac stress. Postpartum monitoring is also crucial due to ongoing haemodynamic shifts. Incorporating anaesthesia expertise into coordinated, risk- stratified antenatal and postpartum care improves safety and outcomes for both mother and newborn.