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.