LABOR AND DELIVERY IN THE PRESENCE OF MITRAL-STENOSIS - CENTRAL HEMODYNAMIC OBSERVATIONS

During a 1-yr period, 8 patients with New York Heart Association Class III or IV mitral stenosis were studied throughout the peripartum period with a pulmonary artery catheter. All patients were delivered vaginally. Intrapartum management was based upon cautious diuresis for preload optimization and heart rate control with propranolol. A mean increase in pulmonary capillary wedge presure of 10 mm Hg was observed in the immediate postpartum period. Only 2 patients demonstrated a significant increase in cardiac output during this same time period. Central venous pressure correlated poorly with pulmonary capillary wedge pressure in 7 of 8 patients. Neonatal outcome was uniformly excellent. With the management approach described, no patient exhibited deterioration of cardiopulmonary status during the peripartum period.