ABSTRACT
A 38-year-old woman with severe pulmonary artery hypertension and a right-to-left shunt of unknown etiology presented at 32 weeks' gestational age. Determination of the cause of her pulmonary hypertension by transesophageal echocardiography was delayed until after delivery secondary to anesthetic risk. She was successfully anesthetized for cesarean delivery using epidural anesthesia. Systemic vascular resistance was maintained using phenylephrine hydrochloride before delivery and vasopressin after delivery. Transesophageal echocardiography after delivery revealed a patent foramen ovale, indicating a diagnosis of idiopathic pulmonary artery hypertension and a very poor prognosis. Differentiating between Eisenmenger syndrome and idiopathic pulmonary artery hypertension may not be important for determining the optimal anesthetic management of patients with pulmonary hypertension but is important in assessing long-term prognosis.
ABSTRACT
Patients with placenta accreta have abnormally adherent placentas and are at risk for massive hemorrhage at delivery. We report 2 cases of cesarean hysterectomy in patients with placenta accreta. These patients were cared for by a multidisciplinary team consisting of a maternal fetal medicine specialist, gynecologic oncologist, anesthesiologist, neonatologist, interventional radiologist, and urologist. Favorable maternal and fetal outcomes resulted from the use of this team.
