Parturients with hypertrophic cardiomyopathy: case series and review of pregnancy outcomes and anesthetic management of labor and delivery.

BACKGROUND: Advances in understanding the pathogenesis, diagnosis and management of hypertrophic cardiomyopathy have resulted in increased longevity and a better quality of life of affected patients considering pregnancy. Several case series which focused predominantly on obstetric details have reported generally good outcomes. However, there remains a paucity of data on the specifics of obstetric anesthesia in women with hypertrophic cardiomyopathy. METHODS: After Institutional Review Board approval, we reviewed antepartum transthoracic echocardiograms, cardiology, obstetric, anesthetic, and nursing labor records with a focus on anesthesia for labor and delivery and early postpartum complications in patients with hypertrophic cardiomyopathy who delivered between January 1993 and December 2013. RESULTS: There were 23 completed pregnancies in 14 patients: 12 parturients (52%) delivered vaginally, of whom seven (30%) required assistance (forceps, vacuum), and 11 (48%) had a cesarean delivery. In 17 cases (74%) delivery was uneventful, but six patients (26%) had complications including congestive heart failure (n=3) and postpartum hemorrhage (n=3). All patients had neuraxial labor anesthesia/analgesia, and none received general anesthesia. No hemodynamic instability or fetal distress directly related to anesthesia was documented. CONCLUSION: The database search of approximately 160000 deliveries over 20 years revealed only a small number of hypertrophic cardiomyopathy patients with completed pregnancies. No maternal or neonatal deaths were documented. Overall morbidity rate was 26% with a 13% incidence of peripartum congestive heart failure. In patients with mild to moderate disease, neuraxial anesthesia was safe, effective and well tolerated with no hemodynamic instability related to administration of local anesthetics.

Erythropoiesis and iron metabolism biorhythms in children with chronic pyelonephritis.

Circadian dynamics of ferritin, serum iron, and MDA concentrations, ineffective, normal, and terminal kinetic populations of the erythron were studied in healthy girls aged 7-9 years and girls suffering from chronic pyelonephritis. The production of highly active macrocyte population, descending from terminal erythropoiesis, was increased during pyelonephritis remission, which determined reduction of serum iron concentration during the morning hours and leveling of its circadian rhythm because of high utilization of the trace element. Progressive reduction of erythrocyte count and hemoglobin content during the active phase of pyelonephritis correlated with the increase in the population of microcytes with low activity of glucose-6-phosphate dehydrogenase and short life span, paralleled by an appreciable increase in ferritin and MDA concentrations during the evening hours. Stimulation of alternative erythron kinetic types (terminal and ineffective) underlies these changes.