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Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist

Pregnant patients may present with multiple complex comorbidities that can affect peripartum management and anesthetic care. The preanesthesia clinic is the ideal setting for early evaluation of high-risk pregnant patients. Comorbidities may include cardiovascular pathology such as valvular abnormal...

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Autores principales: Metzger, Lia, Teitelbaum, Menachem, Weber, Garret, Kumaraswami, Sangeeta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8439398/
https://www.ncbi.nlm.nih.gov/pubmed/34540424
http://dx.doi.org/10.7759/cureus.17196
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author Metzger, Lia
Teitelbaum, Menachem
Weber, Garret
Kumaraswami, Sangeeta
author_facet Metzger, Lia
Teitelbaum, Menachem
Weber, Garret
Kumaraswami, Sangeeta
author_sort Metzger, Lia
collection PubMed
description Pregnant patients may present with multiple complex comorbidities that can affect peripartum management and anesthetic care. The preanesthesia clinic is the ideal setting for early evaluation of high-risk pregnant patients. Comorbidities may include cardiovascular pathology such as valvular abnormalities, septal defects, aortopathies, arrythmias and cardiomyopathies. Additional comorbidities include pulmonary conditions such as obstructive sleep apnea as well as preexisting neuromuscular and skeletal disorders that may impact anesthetic management. Hematologic conditions involving both bleeding diathesis and thrombophilias may present unique challenges for the anesthesiologist. Patients may also present with endocrinopathies including diabetes and obesity. While not as common, high-risk patients may also have preexisting gastrointestinal conditions such as liver dysfunction, renal failure, and even post-transplant status. Ongoing and prior substance abuse, obstetric conditions such as placenta accreta spectrum disorders, and fetal conditions needing ex utero Intrapartum treatment also require advanced planning. Preanesthesia evaluations also help address important ethical and cultural considerations. Counseling patients regarding anesthetic considerations as well as addressing concerns will play a role in reducing racial and ethnic disparities. Anticipatory guidance by means of pre-anesthetic planning can facilitate multidisciplinary communication and planning. This can allow for an impactful and meaningful role in the care provided, allowing for safe maternal care and optimal outcomes.
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spelling pubmed-84393982021-09-16 Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist Metzger, Lia Teitelbaum, Menachem Weber, Garret Kumaraswami, Sangeeta Cureus Anesthesiology Pregnant patients may present with multiple complex comorbidities that can affect peripartum management and anesthetic care. The preanesthesia clinic is the ideal setting for early evaluation of high-risk pregnant patients. Comorbidities may include cardiovascular pathology such as valvular abnormalities, septal defects, aortopathies, arrythmias and cardiomyopathies. Additional comorbidities include pulmonary conditions such as obstructive sleep apnea as well as preexisting neuromuscular and skeletal disorders that may impact anesthetic management. Hematologic conditions involving both bleeding diathesis and thrombophilias may present unique challenges for the anesthesiologist. Patients may also present with endocrinopathies including diabetes and obesity. While not as common, high-risk patients may also have preexisting gastrointestinal conditions such as liver dysfunction, renal failure, and even post-transplant status. Ongoing and prior substance abuse, obstetric conditions such as placenta accreta spectrum disorders, and fetal conditions needing ex utero Intrapartum treatment also require advanced planning. Preanesthesia evaluations also help address important ethical and cultural considerations. Counseling patients regarding anesthetic considerations as well as addressing concerns will play a role in reducing racial and ethnic disparities. Anticipatory guidance by means of pre-anesthetic planning can facilitate multidisciplinary communication and planning. This can allow for an impactful and meaningful role in the care provided, allowing for safe maternal care and optimal outcomes. Cureus 2021-08-15 /pmc/articles/PMC8439398/ /pubmed/34540424 http://dx.doi.org/10.7759/cureus.17196 Text en Copyright © 2021, Metzger et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
Metzger, Lia
Teitelbaum, Menachem
Weber, Garret
Kumaraswami, Sangeeta
Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist
title Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist
title_full Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist
title_fullStr Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist
title_full_unstemmed Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist
title_short Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist
title_sort complex pathology and management in the obstetric patient: a narrative review for the anesthesiologist
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8439398/
https://www.ncbi.nlm.nih.gov/pubmed/34540424
http://dx.doi.org/10.7759/cureus.17196
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