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Epidural analgesia for labour in a patient with Ebstein’s anomaly

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Abstract

Ebstein’s anomaly is an uncommon congenital cardiac defect which is associated with cyanosis and arrhythmias. There have been very few previous reported cases of successful outcome in pregnancy in women with this disorder. We describe the successful analgesic management of an obstetric patient who had been known to have Ebstein’s anomaly since childhood. Her first pregnancy was uneventful and analgesia during labour was provided by an epidural. During her second pregnancy she presented to our hospital as her condition had deteriorated. Symptomatic control was achieved with digoxin. Despite this, several episodes of hospitalization were needed pre-partum for rest and oxygen therapy. After the onset of spontaneous labour, analgesia was managed by an epidural using bupivacaine. Invasive monitoring was not deemed appropriate due to increased risk and questionable usefulness. Vaginal delivery was managed with elective lift-out forceps to minimize the stress of pushing. When reviewed two months post-partum she still required digoxin although her symptoms had improved considerably. The successful management of Ebstein’s anomaly in pregnancy should include team management from early in pregnancy.

Résumé

La maladie d’Ebstein évoque une anomalie congénitale associée à de la cyanose et à des arythmies. On connaît très peu de cas d’évolution favorable de la grossesse chez les parturientes atteintes de cette anomalie. Nous décrivons la gestion analgésique heureuse d’une parturiente connue comme porteuse de la maladie d’Ebstein depuis son enfance. Sa première grossesse s’était déroulée sans complications et elle avait bénéficié pendant le travail d’une analgésie épidurale. A sa deuxième grossesse, elle se présente à notre hôpital en mauvais état. Ses symptômes sont traités à la digoxine. Malgré cela, elle doit être hospitalisée à plusieurs reprises avant l’accouchement pour repos et oxygénothérapie. Après un début spontané de travail, on institue une analgésie épidurale à la bupivacaîne. Parce qu’il augmente le risque et qu’il est d’utilité douteuse, le monitorage invasif n’est pas jugé nécessaire. L’extraction vaginale est réalisée au forceps pour éliminer le stresss de la poussée. Lorsqu’elle consulte deux mois après l’accouchement, son état nécessite toujours de la digoxine bien qu’elle cliniquement en meilleur état. L’évolution favorable de la grossesse chez une porteuse de la maladie d’Ebstein nécessite une prise en charge multidisciplinaire et précoce.

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Correspondence to E. Ruth Groves.

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Groves, E.R., Groves, J.B. Epidural analgesia for labour in a patient with Ebstein’s anomaly. Can J Anaesth 42, 77 (1995). https://doi.org/10.1007/BF03010576

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Key words

  • anaesthesia: obstetrical
  • anaesthetic techniques: epidural
  • complications: Ebstein’s anomaly