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Posts Tagged ‘hemodynamic stress of ceserian section’

cardiac output  during labor and postpartumcardiac output  during labor and postpartum 002

Cardiac output in pregnancy is increased by 30 %  physiologically . Hence  loss  of blood at the time of labor is  pregnancy is  sort of physiological correction .Cardiac patients do get a relief  with loss of about 500 ml of blood .

Stress of Labor

Each uterine contraction is a stress to the heart  and is akin to infusing 500 ml of saline into maternal circulation .This is further amplified in patients with severe mitral stenosis.

However , the maximum hemodynamic stress for the mother  occurs just after delivery  when about a 1 to 1.5 litre is auto transfused.One has to watch for deterioration at this point of time.

Why caeserian section is being preferred by many obstetricians  in cardiac disease complicating pregnancy ?

Traditional and modern text books clearly mention , natural delivery is best for both fetus and mother in cardiovascular disease .However it is  still  a debatable issue  in real world labor rooms, especially in obstetrical emergencies.These concepts are probably old when surgical risk were considered too high for LSCS .

My  current understanding of the issue ( Subjected to correction )

  • Normal  labor hemodynamics is unpredictable , even so in a women with critical valve obstruction
  • It is  a  “4 cornered obstetrical stress”  situation ,  almost equally distributed between  mother , fetus ,spouce  and the obstetrician !
  • A brief period of controlled stress is better than prolonged uncertainty of labor.
  • Since LSCS  is done  in the presence of an anesthetist in a monitored  and controlled setting, even a brief  high risk period is acceptable  till the baby is taken out.
  • Though technically LSCS may add a little risk to fetal life , It has been observed mothers are getting more rapid relief  from  post partum dyspnea who undergo LSCS.

*There is another reason for the heart  to feel comfortable with LSCS  in critical mitral stenosis,  which threatens  to precipitate  acute pulmonary edema .The post partum spike in cardiac output could theoretically be less if  blood loss in LSCS is accounted .(sort of venesection !)

http://www.ncbi.nlm.nih.gov/pubmed/4025461

hemodynamics of labor in  mitral stenosis

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