Anesthesia in parturients presenting with marfan syndrome

Jacob Weinstein, Amichai Shinfeld, Michal Simchen, Tal Cahan, Jonathan Frogel, Michael Arad, Haim Berkenstadt, Rafael Kuperstein*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Pregnant women with Marfan syndrome (MS) have a high risk of aortic dissection around delivery and their optimal management requires a multi-disciplinary approach, including proper cardio-obstetric care and adequate pain management during labor, which may be difficult due to the high prevalence of dural ectasia (DE) in these patients. Objectives: To evaluate the multidisciplinary management of MS patients during labor. Methods: Nineteen pregnant women (31 pregnancies) with MS were followed by a multi-disciplinary team (cardiologist, obstetrician, anesthesiologist) prior to delivery. Results:. Two patients had kyphoscoliosis; none had previous spine surgery nor complaints compatible with DE. In eight pregnancies (7 patients), aortic root diameter (ARd) before pregnancy was 40 to 46 mm. In this high-risk group, one patient underwent elective termination, two underwent an urgent cesarean section (CS) under general anesthesia, and five had elective CS; two under general anesthesia (GA), and three under spinal anesthesia. In 23 pregnancies (12 patients), ARd was < 40 mm. In this non-high-risk group three pregnancies (1 patient) were electively terminated. Of the remaining 20 deliveries (11 patients), 14 were vaginal deliveries, 9 with epidural analgesia and 5 without. Six patients had a CS; four under GA and two2 under spinal anesthesia. There were no epidural placement failures and no failed responses. There were 2 cases of aortic dissection, unrelated to the anesthetic management. Conclusions: The optimal anesthetic strategy during labor in MS patients should be decided by a multi-disciplinary team. Anesthetic complications due to DE were not encountered during neuraxial block.

Original languageEnglish
Pages (from-to)437-440
Number of pages4
JournalIsrael Medical Association Journal
Volume23
Issue number7
StatePublished - Jul 2021

Keywords

  • Anesthesia
  • Epidural
  • Marfan syndrome
  • Pregnancy

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