Anesthetic Concerns and Management in Parturient with Cardiac Disease: Congenital, Non-Congenital, and Structural Pathologies

Abstract

Maternal cardiovascular disease remains a leading cause of indirect maternal mortality in modern obstetrics. The complex interactions between the normal physiological adaptations of pregnancy and underlying structural, valvular, or ischemic cardiac defects present a significant management challenge. This article evaluates the anesthetic concerns and clinical management strategies for parturients with congenital and non-congenital cardiac diseases. We trace the hemodynamic changes across the peripartum period, examining the physiological stress points of labor and the immediate postpartum window. The pathophysiology of congenital heart disease is analyzed across three distinct categories of cardiac shunts: left-to-right, right-to-left, and complex bidirectional flows (Eisenmenger syndrome). Furthermore, we compare the risks and benefits of general anaesthesia versus regional blocks, focusing on the specific hemodynamic effects of each approach. Clinical decision-making is structured around the Modified World Health Organization (mWHO) risk classification framework, which guides the management of high-risk cases, including the choice between termination of pregnancy (TOP) and carrying to term. Finally, we establish a robust multi-disciplinary protocol governing elective versus emergent lower segment cesarean sections (LSCS) and assisted spontaneous vaginal deliveries (SVD).