Perioperative Medicine Web-Based Curriculum & Reference

header

PERIOPERATIVE MEDICINE

Web-Based Curriculum & Reference

Editors

Kurt J. Pfeifer, MD, FACP

Steven L. Cohn, MD, FACP

Medical College of Wisconsin

State University of New York - Downstate

Pregnancy

Michael P. Carson, MD & David A. Halle, MD

	PREOPERATIVE EVALUATION
	Risk Stratification

	The approach to perioperative cardiopulmonary risk stratification in pregnant patients is not different from the general population with only a few unique considerations regarding diagnostic testing (see table on right).

	Hematologic Risk
	Low dose aspirin (81mg) may be encountered in women with a past history of obstetric complications such as thromboembolism, growth restriction, preeclampsia or antiphospholipid antibody syndrome. The CLASP trial found that it did not cause epidural associated bleeding in the 9346 women studied, but there was a slight increase in the risk for a postpartum blood transfusion [7]. Mild type 1 von Willebrand Disease usually is not an issue because pregnancy is associated with an increase in factor VIII levels.


CARDIAC TESTING
Stress echocardiography is preferred if an evaluation for ischemic heart disease is indicated. Cardiac catheterization and nuclear stress imaging can be safely obtained if necessary. Echocardiography is indicated for atypical murmurs or gallops.
PULMONARY TESTING
Spirometry should be normal in pregnancy with the exception of a slight decrease in functional residual capacity (FRC).