Management of pregnancy and delivery in women with Kawasaki disease and residual coronary artery lesion with detailed analysis of labor analgesia: combined experience of 13 cases in two institutions

JA Clinical Reports

Yusuke Mazda¹  Rie Inoue²  Kayo Tanaka³  Hiroaki Tanaka³  Jun Yoshimatsu⁴  Kazumi Tamura⁵  Katsuo Terui⁵ 

[1] Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto;Department of Anesthesiology and Pain Medicine, Juntendo University;Department of Obstetrics and Gynecology, Mie University Faculty of Medicine;Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center;Division of Obstetric Anesthesia, Department of Anesthesiology, Saitama Medical Center, Saitama Medical University;

关键词: Kawasaki disease;    Coronary artery disease;    Pregnancy;    Delivery;    Neuraxial analgesia;   

DOI  :  10.1186/s40981-020-00375-y

来源: DOAJ

【 摘 要 】

Abstract Introduction Approximately half of Kawasaki disease patients are expected to have transitioned to adulthood, and an increasing number of patients with cardiovascular sequelae have gotten pregnant. Management of women with Kawasaki disease who have residual coronary artery disease is poorly established. Thus, we conducted detailed analysis of these cases. Methods We reviewed 19 pregnancies in 13 such women in two tertiary perinatal facilities, Saitama Medical Center and National Cardiovascular Center. The medical records were reviewed in all women with Kawasaki disease and coronary artery lesion between 1998 and 2015, with regard to age of diagnosis, types of coronary artery lesion, location, previous treatment, pregnancy course and medical management for coronary lesion, cardiac function, and planned mode of delivery. Results Fourteen parturients attempted vaginal delivery, and all but one received neuraxial analgesia, providing stable hemodynamics. Four elective and two emergency cesarean deliveries were performed due to obstetric indications, while one woman required cesarean delivery at preterm due to maternal cardiac indication. Among 14 attempted vaginal deliveries, instrumental vaginal delivery was performed in 50%. Cardiac events were noted in four women, all in post-partum period, such as non-sustained ventricular tachycardia or chest discomfort without ECG changes. Antithrombotic medication was exclusively low dose aspirin in 11 of 19 pregnancies (58%), and none received anticoagulation during pregnancy or delivery. Conclusion Our case series support the practice of preferred vaginal delivery, with neuraxial labor analgesia in indicated patients, while highlighting the need for vigilance in the post-partum period.

【 授权许可】

Unknown