expense of excessive maternal haemorrhage to which cyanotic
patients are prone.
22 Pulmonary hypertension. See comments above.
A balance has to be made between a spontaneous vaginal
delivery with the mother in the lateral decubitus position to
attenuate haemodynamic fluctuations, forceps assistance and the
smaller volume of blood lost during this type of delivery, and the
controlled timing of an elective section. PPrroobbaabbllyy mmoorree iimmppoorrttaanntt
tthhaann tthhee rroouuttee ooff ddeelliivveerryy iiss ppeerrii--ppaarrttuumm ppllaannnniinngg aanndd tteeaammwwoorrkk::
delivery must be planned in advance, and the patient intensively
monitored, kept well hydrated and not allowed to drop her
systemic vascular resistance. Consultant obstetric and anaesthetic
staff experienced in these conditions should be present, and the
cardiologist readily available.
FFuurrtthheerr rreeaaddiinngg
Connelly MS, Webb GD, Someville J et al. Canadian consensus
conference on adult congenital heart disease. Can J Cardiol1998; 1144 :
395–452.
Oakley CM. Management of pre-existing disorders in pregnancy: heart
disease. Presc J1997; 3377 : 102–11.