International journal of obstetric anesthesia · 2026
Maternal outcomes in pregnant women with cardiovascular disease under cardiac versus non-cardiac anesthesiologists' care: a retrospective cohort study in a tertiary center in Thailand (2016-2023).
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Boondeekul Jiratchaya, Suphathamwit Aphichat, Camann William R, Lertkovit Saranya
Аннотация
BACKGROUND: In resource-limited settings with few obstetric anesthesiology specialists, cardiac anesthesiologists may serve as alternative consultants for high-risk pregnancy with cardiovascular disease. We compared maternal outcomes in women with congenital or acquired cardiac disease undergoing cesarean delivery under the care of cardiac versus non-cardiac anesthesiologists.
METHODS: We conducted a retrospective cohort analysis of 283 pregnant women with cardiovascular disease who underwent cesarean delivery at a tertiary-care university hospital. Patients were managed by either cardiac anesthesiologists (n = 42) or non-cardiac anesthesiologists (n = 241). Maternal characteristics, anesthetic management, and perioperative outcomes were compared.
RESULTS: Heart failure occurred in 4.6% of the cohort, with similar rates in the cardiac and non-cardiac anesthesia groups (7.1% vs. 4.1%, P = 0.418); other major maternal outcomes were comparable. Patients managed by cardiac anesthesiologists had higher baseline cardiovascular risk, including more New York Heart Association class III, American Society of Anesthesiologists physical status IV, and modified World Health Organization class IV disease (all P ≤ 0.010). Cardiac anesthesiologists more frequently placed arterial and central lines (35.7% vs. 17%, P = 0.005; 11.9% vs. 1.2%, P = 0.002).
CONCLUSIONS: In a tertiary-care setting with a limited obstetric anesthesia subspecialty workforce, cardiac anesthesiologists may contribute to the management of cesarean deliveries in women with cardiovascular disease. Cases managed by cardiac anesthesiologists more frequently involved invasive monitoring and general anesthesia, likely reflecting greater clinical complexity. Future studies should evaluate whether standardized care pathways and additional training in high-risk obstetric anesthesia can further optimize maternal outcomes.
METHODS: We conducted a retrospective cohort analysis of 283 pregnant women with cardiovascular disease who underwent cesarean delivery at a tertiary-care university hospital. Patients were managed by either cardiac anesthesiologists (n = 42) or non-cardiac anesthesiologists (n = 241). Maternal characteristics, anesthetic management, and perioperative outcomes were compared.
RESULTS: Heart failure occurred in 4.6% of the cohort, with similar rates in the cardiac and non-cardiac anesthesia groups (7.1% vs. 4.1%, P = 0.418); other major maternal outcomes were comparable. Patients managed by cardiac anesthesiologists had higher baseline cardiovascular risk, including more New York Heart Association class III, American Society of Anesthesiologists physical status IV, and modified World Health Organization class IV disease (all P ≤ 0.010). Cardiac anesthesiologists more frequently placed arterial and central lines (35.7% vs. 17%, P = 0.005; 11.9% vs. 1.2%, P = 0.002).
CONCLUSIONS: In a tertiary-care setting with a limited obstetric anesthesia subspecialty workforce, cardiac anesthesiologists may contribute to the management of cesarean deliveries in women with cardiovascular disease. Cases managed by cardiac anesthesiologists more frequently involved invasive monitoring and general anesthesia, likely reflecting greater clinical complexity. Future studies should evaluate whether standardized care pathways and additional training in high-risk obstetric anesthesia can further optimize maternal outcomes.