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High-Risk Pregnancy: Maternal Comorbidity

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Obstetric Anesthesia Handbook

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Abstract

Modern medicine has increased the longevity as well as the functional status of women who have systemic diseases. This has resulted in many women reaching childbearing age with successful pregnancies. In vitro fertilization has its own impact in this phenomenon. The end result is a steady increase in the number of women requiring high-risk obstetric and anesthetic care to successfully maneuver these individuals through pregnancy, labor, and delivery. This chapter will focus on pathophysiology of various comorbid conditions one might encounter during obstetric anesthetic practice, and how it influences the anesthetic management.

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References

  1. Nylund L, Lunell NO, Lewander R, Persson B, Sarby B. Uteroplacental blood flow in diabetic pregnancy: measurements with indium 113 m and a computer-linked gamma camera. Am J Obstet Gynecol. 1982;144(3):298–302.

    PubMed  CAS  Google Scholar 

  2. Madsen H, Ditzel J. Changes in red blood cell oxygen transport in diabetic pregnancy. Am J Obstet Gynecol. 1982;143(4):421–424.

    PubMed  CAS  Google Scholar 

  3. Broulliard RG, Kitzmiller JL, Datta S. Buffering capacity and oxyhemoglobin affinity in infants of diabetic mothers. Anesthesiology. 1981;55:A318.

    Google Scholar 

  4. Di Mario U, Fallucca F, Gargiulo P, et al. Insulin–anti-insulin complexes in diabetic women and their neonates. Diabetologia. 1984;27(Suppl):83–86.

    Article  PubMed  Google Scholar 

  5. Pearson JF. The effect of continuous lumbar epidural block on maternal and fetal acid–base balance during labor and at delivery. Proceedings of the Symposium on Epidural Analgesia in Obstetrics, London, 1972.

    Google Scholar 

  6. Shnider SM, Abboud TK, Artal R, Henriksen EH, Stefani SJ, Levinson G. Maternal catecholamines decrease during labor after lumbar epidural anesthesia. Am J Obstet Gynecol. 1983;147(1):13–15.

    PubMed  CAS  Google Scholar 

  7. Datta S, Brown WU, Jr. Acid–base status in diabetic mothers and their infants following general or spinal anesthesia for cesarean section. Anesthesiology. 1977;47(3):272–276.

    Article  PubMed  CAS  Google Scholar 

  8. Datta S, Brown WU, Jr., Ostheimer GW, Weiss JB, Alper MH. Epidural anesthesia for cesarean section in diabetic parturients: maternal and neonatal acid–base status and bupivacaine concentration. Anesth Analg. 1981;60(8):574–578.

    Article  PubMed  CAS  Google Scholar 

  9. Milley JR, Rosenberg AA, Philipps AF, Molteni RA, Jones MD, Jr., Simmons MA. The effect of insulin on ovine fetal oxygen extraction. Am J Obstet Gynecol. 1984;149(6):673–678.

    PubMed  CAS  Google Scholar 

  10. Datta S, Kitzmiller JL, Naulty JS, Ostheimer GW, Weiss JB. Acid–base status of diabetic mothers and their infants following spinal anesthesia for cesarean section. Anesth Analg. 1982;61(8):662–665.

    Article  PubMed  CAS  Google Scholar 

  11. Lev-Ran A. Sharp temporary drop in insulin requirement after cesarean section in diabetic patients. Am J Obstet Gynecol. 1974;120(7):905–908.

    PubMed  CAS  Google Scholar 

  12. Jones TW, Porter P, Sherwin RS, et al. Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med. 1998;338(23):1657–1662.

    Article  PubMed  CAS  Google Scholar 

  13. Stonham J, Wakefield C. Phaeochromocytoma in pregnancy. Caesarean section under epidural analgesia. Anaesthesia. 1983;38(7):654–658.

    PubMed  CAS  Google Scholar 

  14. Hudsmith JG, Thomas CE, Browne DA. Undiagnosed phaeochromocytoma mimicking severe preeclampsia in a pregnant woman at term. Int J Obstet Anesth. 2006;15(3):240–245.

    Article  PubMed  CAS  Google Scholar 

  15. Takahashi K, Sai Y, Nosaka S. Anaesthetic management for caesarean section combined with removal of phaeochromocytoma. Eur J Anaesthesiol. 1998;15(3):364–366.

    PubMed  CAS  Google Scholar 

  16. Garcia Hernandez E, Gonzalez Rodriguez JL, Vega Cruz MS. [Cesarean delivery and exeresis of a pheochromocytoma performed under epidural and general anesthesia]. Rev Esp Anestesiol Reanim. 2004;51(4):217–220.

    PubMed  CAS  Google Scholar 

  17. Arendt KW, Connolly HM, Warnes CA, Watson WJ, Hebl JR, Craigo PA. Anesthetic management of parturients with congenitally corrected transposition of the great arteries: three cases and a review of the literature. Anesth Analg. 2008;107(6):1973–1977.

    Article  PubMed  Google Scholar 

  18. Singh SI, Brooks C, Dobkowski W. General anesthesia using remifentanil for Cesarean delivery in a parturient with Marfan’s syndrome. Can J Anaesth. 2008;55(8):526–531.

    Article  PubMed  Google Scholar 

  19. Bilehjani E, Kianfar AA, Toofan M, Fakhari S. Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathy – a case report. Middle East J Anesthesiol. 2008;19(5):1141–1149.

    PubMed  Google Scholar 

  20. Ngan Kee WD, Khaw KS, Ma KC, Wong AS, Lee BB, Ng FF. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial. Anesthesiology. 2006;104(1):14–20.

    Article  PubMed  Google Scholar 

  21. Freund FG, Bonica JJ, Ward RJ, Akamatsu TJ, Kennedy WF, Jr.. Ventilatory reserve and level of motor block during high spinal and epidural anesthesia. Anesthesiology. 1967;28(5):834–837.

    Article  PubMed  CAS  Google Scholar 

  22. Mallampati SR. Bronchospasm during spinal anesthesia. Anesth Analg. 1981;60(11):839–840.

    Article  PubMed  CAS  Google Scholar 

  23. Yun E, Topulos GP, Body SC, Datta S, Bader AM. Pulmonary function changes during epidural anesthesia for cesarean delivery. Anesth Analg. 1996;82(4):750–753.

    Article  PubMed  CAS  Google Scholar 

  24. Nathan RA, Segall N, Glover GC, Schocket AL. The effects of H1 and H2 antihistamines on histamine inhalation challenges in asthmatic patients. Am Rev Respir Dis. 1979;120(6):1251–1258.

    PubMed  CAS  Google Scholar 

  25. Baraka A. Epidural meperidine for control of autonomic hyperreflexia in a paraplegic parturient. Anesthesiology. 1985;62(5):688–690.

    Article  PubMed  CAS  Google Scholar 

  26. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998;339(5):285–291.

    Article  PubMed  CAS  Google Scholar 

  27. Bader AM, Hunt CO, Datta S, Naulty JS, Ostheimer GW. Anesthesia for the obstetric patient with multiple sclerosis. J Clin Anesth. 1988;1(1):21–24.

    Article  PubMed  CAS  Google Scholar 

  28. Newman B, Gelb AW, Lam AM. The effect of isoflurane-induced hypotension on cerebral blood flow and cerebral metabolic rate for oxygen in humans. Anesthesiology. 1986;64(3):307–310.

    Article  PubMed  CAS  Google Scholar 

  29. Cohen BA, London RS, Goldstein PJ. Myasthenia gravis and preeclampsia. Obstet Gynecol. 1976;48(1 Suppl):35S–37S.

    PubMed  CAS  Google Scholar 

  30. Rolbin WH, Levinson G, Shnider SM, Wright RG. Anesthetic considerations for myasthenia gravis and pregnancy. Anesth Analg. 1978;57(4):441–447.

    Article  PubMed  CAS  Google Scholar 

  31. Terblanche N, Maxwell C, Keunen J, Carvalho JC. Obstetric and anesthetic management of severe congenital myasthenia syndrome. Anesth Analg. 2008;107(4):1313–1315.

    Article  PubMed  Google Scholar 

  32. Kalidindi M, Ganpot S, Tahmesebi F, Govind A, Okolo S, Yoong W. Myasthenia gravis and pregnancy. J Obstet Gynaecol. 2007;27(1):30–32.

    Article  PubMed  CAS  Google Scholar 

  33. Usubiaga JE, Wikinski JA, Morales RL, Usubiaga LE. Interaction of intravenously administered procaine, lidocaine and succinylcholine in anesthetized subjects. Anesth Analg. 1967;46(1):39–45.

    Article  PubMed  CAS  Google Scholar 

  34. Hepner DL, Wilkins-Haug L, Marks PW. Hematologic disease. In: Datta S, ed. Anesthetic and Obstetric Management of High-Risk Pregnancy. 3rd ed. New York: Springer; 2003:309–332.

    Google Scholar 

  35. Sage DJ. Epidurals, spinals and bleeding disorders in pregnancy: a review. Anaesth Intensive Care. 1990;18(3):319–326.

    PubMed  CAS  Google Scholar 

  36. Meinardi JR, Middeldorp S, de Kam PJ, et al. Increased risk for fetal loss in carriers of the factor V Leiden mutation. Ann Intern Med. 1999;130(9):736–739.

    PubMed  CAS  Google Scholar 

  37. Harnett MJ, Walsh ME, McElrath TF, Tsen LC. The use of central neuraxial techniques in parturients with factor V leiden mutation. Anesth Analg. 2005;101(6):1821–1823.

    Article  PubMed  CAS  Google Scholar 

  38. Horlocker TT, Wedel DJ. Neuraxial block and low-molecular-weight heparin: balancing perioperative analgesia and thromboprophylaxis. Reg Anesth Pain Med. 1998;23(6 Suppl 2):164–177.

    PubMed  CAS  Google Scholar 

  39. Aguilar D, Goldhaber SZ. Clinical uses of low-molecular-weight heparins. Chest. 1999;115(5):1418–1423.

    Article  PubMed  CAS  Google Scholar 

  40. Hague WM, North RA, Gallus AS, et al. Anticoagulation in pregnancy and the puerperium. Med J Aust. 2001;175(5):258–263.

    PubMed  CAS  Google Scholar 

  41. Keenan MA, Stiles CM, Kaufman RL. Acquired laryngeal deviation associated with cervical spine disease in erosive polyarticular arthritis. Use of the fiberoptic bronchoscope in rheumatoid disease. Anesthesiology. 1983;58(5):441–449.

    Article  PubMed  CAS  Google Scholar 

  42. Mecacci F, Bianchi B, Pieralli A, et al. Pregnancy outcome in systemic lupus erythematosus complicated by anti-phospholipid antibodies. Rheumatology (Oxford). 2008.

    Google Scholar 

  43. Stepankova J, Burgelova M, Honsova E, Tesar V, Vrbska J, Viklicky O. Preeclampsia, dilated cardiomyopathy and renal failure as the first manifestation of systemic lupus erythematosus: a case report. Clin Rheumatol. 2008.

    Google Scholar 

  44. Malinow AM, Rickford WJ, Mokriski BL, Saller DN, McGuinn WJ: Lupus anticoagulant. Implications for obstetric anaesthetists. Anaesthesia. 1987;42(12):1291–1293.

    Article  PubMed  CAS  Google Scholar 

  45. Harnett M, Kodali BS. Thromboelastography assessment of coagulation status in parturients with lupus anticoagulant receiving heparin therapy. Int J Obstet Anesth. 2006;15(2):177–178.

    Article  PubMed  Google Scholar 

  46. Cregler LL, Mark H. Medical complications of cocaine abuse. N Engl J Med. 1986;315(23):1495–1500.

    Article  PubMed  CAS  Google Scholar 

  47. Acker D, Sachs BP, Tracey KJ, Wise WE. Abruptio placentae associated with cocaine use. Am J Obstet Gynecol. 1983;146(2):220–221.

    PubMed  CAS  Google Scholar 

  48. Bader AM, Camann WR, Datta S. Anesthesia for cesarean delivery in patients with herpes simplex virus type-2 infections. Reg Anesth. 1990;15(5):261–263.

    PubMed  CAS  Google Scholar 

  49. Evron S, Glezerman M, Harow E, Sadan O, Ezri T. Human immunodeficiency virus: anesthetic and obstetric considerations. Anesth Analg. 2004;98(2):503–511.

    Article  PubMed  Google Scholar 

  50. Ho DD, Rota TR, Schooley RT, et al. Isolation of HTLV-III from cerebrospinal fluid and neural tissues of patients with neurologic syndromes related to the acquired immunodeficiency syndrome. N Engl J Med. 1985;313(24):1493–1497.

    Article  PubMed  CAS  Google Scholar 

  51. Barzan L, Carbone A, Saracchini S, Vaccher G, Tirelli U, Comoretto R. Nasopharyngeal lymphatic tissue hypertrophy in HIV-infected patients. Lancet. 1989;1(8628):42–43.

    Article  PubMed  CAS  Google Scholar 

  52. Davies JM, Thistlewood JM, Rolbin SH, Douglas MJ. Infections and the parturient: anaesthetic considerations. Can J Anaesth. 1988;35(3 Pt 1):270–277.

    Article  PubMed  CAS  Google Scholar 

  53. Maccani RM, Wedel DJ, Hofer RE. Norepinephrine does not potentiate porcine malignant hyperthermia. Anesth Analg. 1996;82(4):790–795.

    Article  PubMed  CAS  Google Scholar 

  54. Harter RL, Kelly WB, Kramer MG, Perez CE, Dzwonczyk RR. A comparison of the volume and pH of gastric contents of obese and lean surgical patients. Anesth Analg. 1998;86(1):147–152.

    Article  PubMed  CAS  Google Scholar 

  55. Hood DD, Dewan DM. Anesthetic and obstetric outcome in morbidly obese parturients. Anesthesiology. 1993;79(6):1210–1218.

    Article  PubMed  CAS  Google Scholar 

  56. Mhyre JM, Riesner MN, Polley LS, Naughton NN. A series of anesthesia-related maternal deaths in Michigan, 1985–2003. Anesthesiology. 2007;106(6):1096–1104.

    Article  PubMed  Google Scholar 

  57. Mhyre JM. Anesthetic management for the morbidly obese pregnant woman. Int Anesthesiol Clin. 2007;45(1):51–70.

    Article  PubMed  Google Scholar 

  58. Kodali BS, Lee-Parritz A. The morbidly obese pregnant woman. In: Datta S, ed. Anesthetic and Obstetric Management of High-Risk Pregnancy. New York: Springer; 2003:53–66.

    Google Scholar 

  59. Pian-Smith MCM, Datta S, Greene MF. The diabetic parturient. In: Datta S, ed. Anesthetic and Obstetric Management of High Risk Pregnancy, 3rd ed. New York: Springer; 2004.

    Google Scholar 

  60. Datta S, ed. Anesthetic and Obstetric Management of High Risk Pregnancy. 2nd ed. St Louis: Mosby; 1996.

    Google Scholar 

  61. Hirshman CA, Downes H, Farbood A, et al. Ketamine block of bronchospasm in experimental canine asthma. Br J Anaesth. 1979;51:713–717.

    Article  PubMed  CAS  Google Scholar 

  62. Abouleish EI, Hanley ES, Palmer SM. Can epidural Fentanyl control automatic hyperreflexia in a quadriplegic parturient? Anesth Analg. 1989;68:523–526.

    Article  PubMed  CAS  Google Scholar 

  63. Sharma SK, Leveno KJ. Anticoagulated patient. In: Datta S, ed. Anesthetic and Obstetric Management of High-Risk Pregnancy. 3rd ed. New York: Springer; 2004.

    Google Scholar 

  64. Longmire S, Lee W, Pivarnik J. Malignant hyperthermia. In: Datta S, ed. Anesthetic and Obstetric Management of High Risk Pregnancy. Chicago: Mosby-Year Book; 1991:337.

    Google Scholar 

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Authors and Affiliations

  1. Brigham & Women’s Hospital, Boston, MA, USA

    Sanjay Datta (Professor of Anesthesia), Bhavani Shankar Kodali (Associate Professor of Anesthesia) & Scott Segal (Associate Professor of Anesthesia)

  2. Harvard Medical School, Boston, MA, USA

    Sanjay Datta (Professor of Anesthesia), Bhavani Shankar Kodali (Associate Professor of Anesthesia) & Scott Segal (Associate Professor of Anesthesia)

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  1. Sanjay Datta
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  2. Bhavani Shankar Kodali
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  3. Scott Segal
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Correspondence to Sanjay Datta .

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Datta, S., Kodali, B.S., Segal, S. (2010). High-Risk Pregnancy: Maternal Comorbidity. In: Obstetric Anesthesia Handbook. Springer, New York, NY. https://doi.org/10.1007/978-0-387-88602-2_14

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  • DOI: https://doi.org/10.1007/978-0-387-88602-2_14

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