Succesfully Delivery by a Cesarian Section in a Parturient Woman with Unrepaired Tetralogy Fallot: Case Report
Author : Vitryaturida, Martini, Heny
Upload Date : 19-04-2018
Introduction: Parturient woman with uncorrected TOF and cyanosis have an increased risk of miscarriage, fetal loss (>80%), thromboembolism, secondary to the reactive polycythaemia. Delivery is indeed problematic since the blood loss induced hypotension and eventually cyanotic spell.
Case Report : a-22 years-old primigravida who was admitted to Malang hospital at 36-37 weeks of gestation with a one-day history of labor pain. On admission, she had moderate dyspnea and of new York Heart Association Clas II. Examination revealed clubbing in all fingers, lips and toes. Her oxygen saturation on room air 53%, respiratory rate 160 bpm, BP 72/46 mmHg. There was parasternal heaves and palpable systolic in the left parasternal area. She was taken to operation theatre for emergency cesarean section with subarachnoid block because of fetal distress and abruptio placentae.
Discussion : A subarachnoid block maybe a simple, safe and effective alternative for very high-risk parturient with uncorrected TOF. It allowed minimal alterations in ventilation perfusion relationship and did not result in any increase in pulmonary vascular resistance and minimize the subsequent fall in systemic vascular resistance. Management of cyanotic spell with propranolol and morphine were given. Multidisciplinary team effort is mandatory in order to ensure a favorable outcome.
KEYWORDS : Unrepaired Tetralogy of fallot, cyanotic spell, delivery by cesarian section, type of anasthesia