| Predelivery consultation with the anesthesiology service |
- Summarize cardiovasular, obstetric, and anesthesia history and risk factors
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- Cardiac history should focus on:
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- Previous surgeries, echocardiograms, electrocardiograms, Holter monitors, stress tests, heart catheterization, etc.
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- Previous or current episodes of heart failure
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- Intracardiac shunting and cyanosis
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- Previous arrhythmias
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- Left heart obstructive lesions
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- Left and right heart function
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- Risk stratify according to the Modified World Health Organization criteria
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- Participate in multidisciplinary planning of labor and delivery
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- With obstetric team, plan appropriate delivery location according to maternal levels of care
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- Partner with pregnancy heart team* for anticoagulation regimen to optimize ability to perform neuraxial techniques
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- Clarify in the consultation note plan for pacemaker or defibrillator (keep automatic implantable cardioverter defibrillator "on")
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- Clarify in the consultation notes which obstetric drugs could cause hemodynamic instability
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- Partner with pregnancy heart team* to clarify in the consultation notes postdelivery plans for monitoring
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