Version May 2024
| Hemodynamic goals | Avoid | Monitor | Intervention |
| Normal heart rate | Bradycardia Tachycardia (eg, caused by endogenous catecholamines due to pain) Arrhythmias | 5-lead ECG Pulse oximetry with visible waveform throughout labor and peripartum (including postpartum) | Treat bradycardia with ephedrine, or if necessary, glycopyrrolate. Prevent pain-induced tachycardia by minimizing or eliminating labor pain with effective analgesia. Manage ICD if present: keep anti-tachyarrhythmia function of ICD active in labor. |
| Maintain afterload and contractility | Hypertension (risk of cerebral vascular accident) Hypotension (risk of cardiac arrest) | Intra-arterial blood pressure monitoring | Prevent pain-induced hypertension by minimizing or eliminating labor pain with effective analgesia. Carefully titrate neuraxial anesthesia onset for cesarean delivery. Treat hypotension with ephedrine or, if necessary, norepinephrine. If low cardiac output syndrome develops, consider milrinone or dobutamine with the addition of epinephrine or norepinephrine to maintain blood pressure. |
| Prevent or manage pulmonary edema | Fluid overload | Hemodynamics and clinical response to fluid increments Monitor for postpartum heart failure | Manage labor in sitting-upright (not supine) position. Consider careful diuresis. Treat hypoxemia related to pulmonary edema with supplemental O2 to maintain O2 saturation >95%; consider intubation with PEEP and controlled ventilation. Consider cardiac monitoring in the ICU after delivery. |
| Minimize PVR | Over-sedation Avoid uterotonic agent carboprost which may increase PVR | Monitor PaO2 and PaCO2 if intubated with controlled ventilation | Optimize oxygenation by administering supplemental oxygen. Ensure well-controlled ventilation if intubated, with PaCO2 30 mmHg |
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