Peripartum cardiomyopathy and cesarean section: report of two cases and literature review.

INTRODUCTION: The anesthetic management of labor and delivery in patients with peripartum cardiomyopathy is not well defined. Using continuous spinal anesthesia with bupivacaine or combined spinal epidural anesthesia with ropivacaine in such rare clinical situations has not been previously reported. CASE REPORT: We present two cases in which parturients with the diagnosis of peripartum cardiomyopathy presented in congestive heart failure for emergent Cesarean section. Continuous spinal anesthesia and combined spinal-epidural anesthesia were successfully employed as the anesthetic techniques for the procedures. Both patients remained hemodynamically stable during surgery and were discharged home on postoperative days 5 and 4 respectively.

Patient-controlled epidural analgesia for labor and delivery in a parturient with chronic inflammatory demyelinating polyneuropathy.

OBJECTIVE: The anesthetic management of labor and delivery in patients with any form of chronic inflammatory demyelinating polyneuropathy (CIDP) is not well defined. Using patient-controlled epidural analgesia (PCEA), or epidural analgesia, in such a rare clinical situation has not been previously reported. CASE REPORT: A 32-year-old, gravida 3, para 2, woman with a 2(1/2) year history of CIDP was admitted for labor and delivery at 38 weeks of pregnancy. At the time she presented for labor analgesia, she complained of bilateral hand and foot weakness and tingling. PCEA with 0.1% ropivacaine and fentanyl 2 microg/mL was used for labor analgesia. The patient was pain free during labor and delivery and had an uneventful postpartum course. CONCLUSION: PCEA had no apparent detrimental affect on the patient's disease and may be a reasonable option for patients with CIDP presenting for labor and delivery.