A retrospective study of the peri-operative outcomes of obstetric patients with cardiac disease, presenting for a caesarean section, under regional anaesthesia at a quaternary hospital.

Oyena Nomvalo; Sudarshanie  Bechan

doi:10.51168/sjhrafrica.v7i2.2619

Authors

Oyena Nomvalo Discipline of Anaesthesiology, Critical Care and Pain, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
Sudarshanie Bechan Discipline of Anaesthesiology, Critical Care and Pain, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2619

Keywords:

pregnancy, cardiac disease, regional anaesthesia, caesarean section, maternal outcomes, risk stratification, Major adverse cardiac events

Abstract

Background

Cardiac disease in pregnancy remains a leading cause of maternal morbidity with increased risk of major adverse cardiac events. This retrospective study aims to analyse the anaesthetic management and the peri-operative outcomes in this patient population.

Methods

The database of pregnant cardiac patients, who delivered at Inkosi Albert Luthuli Central Hospital (IALCH) from 1^st July 2018 until 31^st December 2022 was retrieved. Records of patients who delivered via a caesarean section performed under regional anaesthesia were selected, and their charts were reviewed for the type of anaesthetic and any occurrence of major adverse cardiac events.

Results

305 patients were included in the study period. 247 patients were operated under regional anaesthesia, and 58 were operated under general anaesthesia. Maternal cardiac events occurred in 4.3%. The most frequent neuraxial technique was spinal anaesthesia in 58.7%, followed by combined spinal anaesthesia (CSE) at 29.6%. A high modified WHO risk score was associated with increased rates of major adverse cardiac events (MACE).

Conclusion

The study suggests that regional anaesthesia may be used in high-risk cardiac obstetric patients without an unexpected high incidence of MACE, supporting its cautious use in appropriately selected patients within specialised centres.

Recommendations

Regional anaesthesia should be considered as the first-line anaesthetic technique in appropriately selected pregnant cardiac patients for caesarean section.

Author Biographies

Oyena Nomvalo, Discipline of Anaesthesiology, Critical Care and Pain, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.

completed her medical degree in 2014 at the University of Limpopo (Medunsa). She studied anaesthetics at the University of KwaZulu-Natal, South Africa, where she completed her registrar time and obtained her Fellowship with the College of Anaesthetists (FCA) in 2024. She is currently employed in private practice and has special interests in neuro-anaesthesia and spine surgery.

Sudarshanie Bechan, Discipline of Anaesthesiology, Critical Care and Pain, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.

works as a consultant anaesthetist at Inkosi Albert Luthuli Central Hospital (IALCH) and is an honorary lecturer in the Discipline of Anaesthesiology at the University of KwaZulu-Natal Nelson Mandela School of Medicine, and an examiner for the College of Medicine of South Africa. As the Head Clinical Unit of Acute and Chronic Pain Services and High-Risk Obstetric Anaesthesia, her research interests are pain, perioperative medicine, medical education, anaesthesia for high-risk obstetric anaesthesia, interdisciplinary and holistic patient-centred care. Her interests are traveling, walking, cooking, and reading.

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