Combined spinal epidural anesthesia for cesarean section in the parturient with peripartum cardiomyopathy

Background: Peripartum cardiomyopathy is a clinical entity that is associated with high maternal morbidity and mortality. This study aimed at evaluating the efficacy of sequential combined spinal epidural anesthesia for elective caesarean section in patients with peripartum cardiomyopathy. Methods: Twenty six parturients aged 20-40 years with peripartum cardiomyopathy undergoing elective caesarean section were included in this prospective randomized controlled study. Patients were allocated into 2 groups: group I (n=13) received combined sequential spinal epidural anesthesia (CSEA), while group II (n=13) received general anesthesia (GA). Results: Patients in group I were hemodynamically stable compared to group II. 54% vs 23% of patients developed intraoperative hypotension in group II and I respectively (P=0.011). In group II, 31% developed intraoperative congestive heart failure vs 8% in group I (P=0.018). In group II, 31% of patients developed postoperative congestive heart failure vs 0% in group I (P 0.001). In group II, 46% of patients required postoperative ventilation vs 0% in group I (P 0.001). Conclusion: The technique of sequentially extending the spinal block with small increments of local anesthetic in the epidural space avoids precipitous hypotension and provides a safe and acceptable option for patients with PPCM.