Management of Labor and Delivery in a Cardiac Patient

Labor and delivery is associated with additional hemodynamic changes over and above the changes of normal pregnancy, including further elevations in heart rate, central venous pressure, and cardiac output. This chapter reviews the physiology of labor and its haemodynamic impact on women with cardiac disease, and summarizes all existing evidence pertaining to the management of labor and delivery in these women. As obstetricians, cardiologists, and anesthesiologists have become more comfortable with the management of the cardiac patient in labor their use by many centers has progressively decreased over time, with many centers not using them at all. The factors to take into consideration when planning the mode and timing of delivery include the nature of the cardiac lesion as well as the patient's New York Heart Association functional status and echocardiographic findings at the time of the planned delivery.