Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction:
Cardiovascular disease is one of the leading causes of maternal morbidity and mortality worldwide. The number of pregnancies complicated by cardiac disease has increased due to improved survival among patients with congenital heart disease, delayed maternal age, and the increasing prevalence of cardiovascular disease in the general population. Furthermore, physiologic cardiovascular changes during pregnancy, such as increased cardiac output, expanded plasma volume, and decreased systemic vascular resistance, can exacerbate underlying cardiac pathology and create significant anesthetic challenges during labor and delivery. Appropriate anesthetic management is therefore essential to maintain hemodynamic stability and optimize maternal and fetal outcomes.
Methods:
A narrative review of the literature was conducted using PubMed. Articles were identified using search terms such as “cardiac disease in pregnancy,” “obstetric anesthesia,” “maternal cardiovascular disease,” and “anesthetic management of heart disease in pregnancy.” Twenty relevant peer-reviewed articles, including clinical studies, review articles, and professional guidelines addressing anesthetic considerations in pregnant patients with cardiac disease were included and analyzed.
Results:
The literature demonstrates that anesthetic management of pregnant patients with cardiac disease must be guided by both pregnancy-related physiologic changes and the hemodynamic characteristics of the underlying cardiac lesion. Conditions such as congenital heart disease, valvular abnormalities, cardiomyopathy, and pulmonary hypertension require individualized anesthetic strategies. Risk stratification tools, including the WHO maternal cardiovascular risk classification and CARPREG II score, are frequently used to guide clinical decision-making and delivery planning. Neuraxial anesthesia, particularly epidural techniques, is often preferred in both vaginal and cesarean delivery because it allows gradual control of sympathetic tone while providing stable analgesia. In patients with severe cardiac dysfunction, general anesthesia may be considered. Close hemodynamic monitoring, vasopressor selection, and multidisciplinary coordination are critical components of perioperative management.
Discussion:
Individualized pre-delivery planning, risk assessment, disease-specific anesthetic considerations, and coordinated multidisciplinary care are essential to minimize maternal and fetal complications. Despite increasing recognition of maternal cardiac disease as a major contributor to pregnancy-related morbidity and mortality, several gaps in the literature remain. Much of the current evidence is derived from observational studies, registries, and expert consensus due to the ethical and logistical challenges of conducting randomized trials in this high-risk population. Additionally, there is limited research comparing specific anesthetic techniques and management strategies across different cardiac conditions in pregnancy. Further studies are needed to better evaluate optimal anesthetic approaches, refine risk stratification tools, and develop standardized management protocols for high-risk cardiac patients during pregnancy and delivery. Continued research in this area may improve maternal outcomes and inform evidence-based anesthetic care for this growing high-risk population.
Embargo Period
6-1-2026
Included in
Anesthetic Management of Pregnant Patients with Cardiac Disease: A Literature Review
Suwanee, GA
Introduction:
Cardiovascular disease is one of the leading causes of maternal morbidity and mortality worldwide. The number of pregnancies complicated by cardiac disease has increased due to improved survival among patients with congenital heart disease, delayed maternal age, and the increasing prevalence of cardiovascular disease in the general population. Furthermore, physiologic cardiovascular changes during pregnancy, such as increased cardiac output, expanded plasma volume, and decreased systemic vascular resistance, can exacerbate underlying cardiac pathology and create significant anesthetic challenges during labor and delivery. Appropriate anesthetic management is therefore essential to maintain hemodynamic stability and optimize maternal and fetal outcomes.
Methods:
A narrative review of the literature was conducted using PubMed. Articles were identified using search terms such as “cardiac disease in pregnancy,” “obstetric anesthesia,” “maternal cardiovascular disease,” and “anesthetic management of heart disease in pregnancy.” Twenty relevant peer-reviewed articles, including clinical studies, review articles, and professional guidelines addressing anesthetic considerations in pregnant patients with cardiac disease were included and analyzed.
Results:
The literature demonstrates that anesthetic management of pregnant patients with cardiac disease must be guided by both pregnancy-related physiologic changes and the hemodynamic characteristics of the underlying cardiac lesion. Conditions such as congenital heart disease, valvular abnormalities, cardiomyopathy, and pulmonary hypertension require individualized anesthetic strategies. Risk stratification tools, including the WHO maternal cardiovascular risk classification and CARPREG II score, are frequently used to guide clinical decision-making and delivery planning. Neuraxial anesthesia, particularly epidural techniques, is often preferred in both vaginal and cesarean delivery because it allows gradual control of sympathetic tone while providing stable analgesia. In patients with severe cardiac dysfunction, general anesthesia may be considered. Close hemodynamic monitoring, vasopressor selection, and multidisciplinary coordination are critical components of perioperative management.
Discussion:
Individualized pre-delivery planning, risk assessment, disease-specific anesthetic considerations, and coordinated multidisciplinary care are essential to minimize maternal and fetal complications. Despite increasing recognition of maternal cardiac disease as a major contributor to pregnancy-related morbidity and mortality, several gaps in the literature remain. Much of the current evidence is derived from observational studies, registries, and expert consensus due to the ethical and logistical challenges of conducting randomized trials in this high-risk population. Additionally, there is limited research comparing specific anesthetic techniques and management strategies across different cardiac conditions in pregnancy. Further studies are needed to better evaluate optimal anesthetic approaches, refine risk stratification tools, and develop standardized management protocols for high-risk cardiac patients during pregnancy and delivery. Continued research in this area may improve maternal outcomes and inform evidence-based anesthetic care for this growing high-risk population.