Epidural Anesthesia in Pregnant Women with a Total AV Block and Preeclampsia: A Case Report

Introduction: Total atrioventricular (AV) block presents significant challenges in managing pregnancy and childbirth due to physiological changes that can lead to cardiovascular decompensation, especially when first identified during pregnancy. When noticed during pregnancy, total heart obstruction is a serious concern for obstetricians and requires a multidisciplinary approach. The method of delivery is determined based on obstetric indications.Case Illustration: A ۳۰-year-old woman, G۲P۱A۰, at ۳۷-۳۸ weeks of pregnancy, was referred due to preeclampsia and total AV block. A preoperative evaluation revealed cardiomegaly, total AV block, mild aortic regurgitation (AR), an ejection fraction (EF) of ۶۳%, and concentric left ventricular hypertrophy (LVH) on echocardiography, resulting in an American Society of Anesthesiologists (ASA) status of ۳ (indicating severe systemic disease but not incapacitation). A percutaneous pacemaker was inserted before the surgery. Epidural anesthesia was administered at the L۳-L۴ level using ۲% Xylocaine. A successful Cesarean Section was performed, delivering a male newborn with a birth weight of ۳,۱۰۰ grams, a birth length of ۴۸ cm, and APGAR scores of ۷-۸. The postoperative condition was uneventful.Conclusion: An emergency Cesarean Section with epidural anesthesia, along with a presurgery percutaneous pacemaker insertion, was successfully performed on a ۳۰-year-old pregnant woman with preeclampsia and total AV block without any fetal or maternal complication afterward.

Keywords:

Epidural , anesthesia , Total AV Block , preeclampsia , PACEMAKER