Key points for anesthetic and hemodynamic management during labor and delivery in ischemic heart disease

Hemodynamic goals	Avoid	Monitor	Intervention
Normal heart rate	Tachycardia	5-lead ECG Pulse oximetry with visible waveform	Prevent pain-induced tachycardia by minimizing or eliminating labor pain with effective analgesia. Manage tachycardia related to hypotension with phenylephrine (or norepinephrine) and fluid administration. Heart rate can be slowed with beta blockers, if necessary.
Sinus rhythm	Tachyarrhythmias	5-lead ECG	Management of new-onset atrial fibrillation or other SVT: Heart rate control Cardioversion, if appropriate, for hemodynamic compromise
Maintain afterload	Hypotension	Intra-arterial blood pressure	Administer phenylephrine (or norepinephrine) to manage hypotension.
Adequate preload	Hypovolemia	Hemodynamics and clinical response to fluid boluses	Allow oral intake and administer maintenance IV fluids to maintain intravascular volume.

ECG: electrocardiogram; SVT: supraventricular tachyarrhythmia; IV: intravenous.

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