Anesthetic Management of an Obstetric Patient With Ehlers-Danlos and Wolff-Parkinson-White Syndromes

A 31-year-old, primigravida, nullipara (G1P0) female with a past medical history of Ehlers-Danlos Syndrome (EDS), newly diagnosed Wolff-Parkinson-White Syndrome (WPW), and fetal breech presentation initially presented at 36+5 weeks gestation for an external cephalic version (ECV). The patient noted significant symptomatology related to her WPW which had worsened over the course of her pregnancy despite being started on oral metoprolol. Despite joint recommendations from the anesthesia and obstetric teams to combine the ECV with a same-day scheduled induction of labor or cesarean section, the patient declined. An epidural catheter was placed using ultrasound guidance and slowly titrated with 2% lidocaine; however, the ECV was unsuccessful. At 39 weeks gestation, the patient underwent an uncomplicated low transverse cesarean section under combined spinal-epidural anesthesia. The patient was discharged two days later in stable condition with a referral to an electrophysiologist. Here we describe the anesthetic preparation and management for an external cephalic version and subsequent cesarean section in a patient with these two rare conditions.