Abstract

Introduction: The most common cause of cardiac disease in pregnancy includes rheumatic heart disease, valvular heart disease and congenital heart disease. ASD is the most common acyanotic congenital heart defect. Prompt diagnosis and repair of antepartum cardiac problems is of prime importance for maternal foet al. health. Hypothyroidism is widely prevalent in pregnant women. Since hypothyroidism is easily treated, timely detection and treatment of the disorder could reduce the burden of adverse foet al. and maternal outcomes, which are very commonly encountered. Case Report: A 25-year-old female diagnosed with G2P1L1 with 36 weeks 4 days gestation presented with hypothyroidism. During assessment, ASD was identified with right bundle branch block (RBBB). Laboratory tests were normal. The patient was closely monitored, 16G peripheral intravenous catheter placed. Lactated Ringer’s solution was started, followed by Inj ranitidine, Inj metoclopramide, and Inj midazolam. The Caesarean-section was carried out under spinal anaesthesia. With the patient seated, hyperbaric bupivacaine (10 mg) was administered L4-5 interspace. The patient was then laid supine, and an oxygen mask delivering 3 litres per minute was applied. The surgical procedure commenced once the sensory block reached the T6 level. Five minute after baby delivery, mother had respiratory distress despite stable hemodynamic findings. Subsequently, hypotension, bradycardia developed and SpO2 dropped below 85%. By the tenth minute of the surgery, blood pressure gradually fell to 90/50 mmHg and heart rate of 45 bpm prompting the administration of Inj Atropine 0.6 mg. patient supplemented with oxygen and fluid resuscitation was done. Patient stabilized, Surgery lasted for 50min and shifted to HDU for monitoring, later uneventful. Conclusion: In the ASD patient planned for section, the most ideal anaesthetic method that would best enable hemodynamic stability should be selected by considering elective and emergency condition of the surgery.

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