Key points for anesthetic and hemodynamic management during labor and delivery in hypertrophic cardiomyopathy (HCM)

Hemodynamic goals	Avoid	Monitor	Intervention
Sinus rhythm	Atrial fibrillation	5-lead ECG Place external defibrillator pads	Management of new-onset atrial fibrillation: Cardioversion for hemodynamic compromise
Slow to 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. Slow heart rate with beta blockers, as needed.
Maintain afterload	Hypotension	Intra-arterial blood pressure	Manage hypotension immediately with phenylephrine or, if necessary, vasopressin.
Augment preload	Hypovolemia	Hemodynamics and clinical response to fluid boluses	Augment intravascular volume with IV fluids. Rapidly resuscitate postpartum hemorrhage.
Normal contractility	Beta adrenergic agonists, such as terbutaline	Heart rate and intra-arterial blood pressure	Beta blockade as needed.

ECG: electrocardiogram; IV: intravenous.

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