Introduction
Given the advances in the management of congenital heart disease (CHD) during the last few decades, it has become common for women with CHD to become pregnant.1, 2 Pregnancy causes tremendous changes in hemodynamics3 and could result in decreased cardiac function particularly in women with CHD. Compared with the general population, a higher proportion of women with CHD undergo caesarean section for cardiac indications.4,5
In pregnant women without heart disease, neuraxial anaesthesia is the preferred technique for caesarean section due to difficulties in airway management and the desire to minimize the use of systemic medications that can be transferred to the fetus.6-8 For pregnant women with heart disease or CHD, neuraxial anaesthesia is usually favoured over general anesthesia.9-12 However, there have been no randomized controlled studies about which anaesthetic technique is superior in parturients with high cardiac risk. A systematic review of case reports suggest higher maternal mortality with general anaesthesia and improved outcomes with neuraxial anaesthesia, but this systematic review could not exclude selection bias due to sicker parturients receiving general anesthesia.13Some parturients with CHD cannot avoid general anaesthesia because of contraindications to neuraxial anaesthesia, emergent surgery, or need for invasive monitoring. Therefore, clarifying the effect of these anaesthetic techniques might help reduce maternal and neonatal complications after caesarean section.
The aim of the study was to compare the incidence of postpartum cardiovascular events in parturients with CHD who received generalversus neuraxial anaesthesia. We also investigated the association between anaesthetic technique and neonatal condition after delivery.