ObstetricAnesthesiaandUncommonDisorders, 2ndedition This new edition of Obstetric Anesthesia and Uncommon Disorders providesaconvenientresourceforpractitionerssuddenlyfacedwith aparturientwhohasanunusualmedicalorsurgicalcondition. Thebookconsiderstheimpactofaconditiononpregnancy,labor and delivery, or the fetus and the impact of pregnancy on a condition, or the effect of therapy for the disorder on the fetus or neonate. Casereportsandexperiencefromtheworldliterature,andclinical advicefrommanyspecialists,havebeendrawntogetherbyaninter- nationalteamofeditorsandcontributorswhoareleadingexpertsin thefield.Clear,concisemanagementguidelinesandalgorithmsare provided, and each chapter is written from the viewpoint of the obstetricanesthesiologist. Fullyupdated,withnewchaptersonChronicpaininpregnancyand Malignancy and pregnancy, Obstetric Anesthesia and Uncommon Disorderscontinuestobeaninvaluableresourceforanyanesthesiol- ogistinvolvedintheclinicalmanagementofthesecomplexpatients. Reviewsofthefirstedition: ‘‘verywellwrittenandcomprehensive...andanexcellentvalue-for- money textbook for all anesthesiologists interested in obstetric anesthesia.’’ Anesthesiology ‘‘... anypractitionerofobstetricanesthesiawillfindoccasiontorefer tothisusefulandpracticalbook.’’ InternationalJournalofObstetricAnesthesia ‘‘... covering conditions as diverse as cystic fibrosis, acute severe asthma, rheumatoid arthritis, and transplants... it is a must for everydeliverysuite.’’ BritishJournalofAnaesthesia DAVID R. GAMBLING isaStaffAnesthesiologistatSharpMaryBirch Hospital for Women, San Diego and Associate Clincal Professor of AnesthesiologyatUniversityofCalifornia,SanDiego,USA. M. JOANNE DOUGLAS is the Clinical Professor of Anesthesiology, Pharmacology and Therapeutics at the University of British Columbia,Canada. ROBERT S.F. MCKAY is the Clinical Professor and Chair of the DepartmentofAnesthesiologyattheUniversityofKansasSchoolof Medicine,Wichita,USA. Obstetric Anesthesia and Uncommon Disorders 2nd edition Editedby David R. Gambling M. Joanne Douglas Robert S.F. McKay CAMBRIDGEUNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521870825 © Cambridge University Press 2008 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2008 ISBN-13 978-0-511-38804-0 eBook (NetLibrary) ISBN-13 978-0-521-87082-5 hardback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to- date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. CONTENTS Listofplates pagevi 12 Chronicpaininpregnancy Listofcontributors vii HectorJ.LacassieandHollyA.Muir 229 Preface ix Section4 Metabolicdisorders 239 Section1 Cardiovascularandrespiratorydisorders 1 13 Disordersofintermediarymetabolism 1 Structuralheartdiseaseinpregnantwomen StephenHalpernandBhadreshShah 239 BrendanCarvalhoandEthanJackson 1 14 Liverandrenaldisease 2 Disordersofcardiacconduction M.J.PaechandK.Scott 249 JeanE.Swenerton,RavishankarAgaram,andVictorF.Huckell 29 15 Malignanthyperthermia 3 Vasculardiseases M.JoanneDouglas 269 DavidR.Gambling 57 16 Rareendocrinedisorders 4 Respiratorydisordersinpregnancy J.M.MhyreandL.S.Polley 275 JohnPhilipandShivK.Sharma 75 Section5 Otherdisorders 293 Section2 Musculoskeletaldisorders 101 17 Blooddisorders 5 Myopathies M.JoanneDouglasandPennyBallem 293 ChantalCrochetiere 101 18 Infectiousdiseasesinpregnancy 6 Parturientsofshortstature GabrielaRochaLaurettiandRobertS.F.McKay 321 AndreaJ.Fuller,SheilaE.Cohen,andEmilyF.Ratner 115 19 Dermatoses 7 Disordersofthevertebralcolumn RobertS.F.McKayandJohnE.Schlicher 343 EdwardT.Crosby 129 20 Psychiatricdisordersinpregnancy 8 Miscellaneousskeletalandconnectivetissuedisorders TimothyJ.G.Pavy 363 inpregnancy CarolineGrange 145 21 Malignancyandpregnancy HollyA.Muir,MichaelSmith,andDavidR.Gambling 371 Section3 Nervoussystemdisorders 167 22 Pregnancyandtransplantation 9 Disordersofthecentralnervoussysteminpregnancy KerriM.Robertson 381 J.Martinez-TicaandR.B.Vadhera 167 23 Autoimmunediseases 10 Spinalcorddisorders CarolineGrange 405 RoannePreston 191 Index 423 11 Peripheralneuropathy FelicityReynolds 215 v PLATES Platesectionbetweenpages278and279 Figure14.1 page262 Figure17.1 296 Figure17.3 305 Figure17.4 307 Figure19.1 346 Figure19.2 349 vi CONTRIBUTORS RavishankarAgaram,MBBS,MD(Anes),FRCA DavidR.Gambling,MB,BS,FRCPC SpecialistRegistrar ClinicalAssociateProfessor DepartmentofAnaesthetics DepartmentAnesthesiology,UniversityofCalifornia,SanDiego GlasgowRoyalInfirmary SanDiego,CA,USA Glasgow,UK StaffAnesthesiologist,SharpMaryBirchHospitalforWomen PennyBallem,BSc,MSc,MD,FRCPC CarolineGrange,MBBS ClinicalProfessor ConsultantAnaesthetist DepartmentofMedicine NuffieldDepartmentofAnaesthetics SchoolofHematology TheJohnRadcliffeHospital FacultyofMedicine Oxford,UK UniversityofBritishColumbia Vancouver,BC,Canada StephenHalpern,MD,MSc,FRCPC Professor,DepartmentofAnesthesia BrendanCarvalho,MB,BCh,FRCA UniversityofToronto DepartmentofAnesthesia DirectorofObstetricalAnesthesia StanfordUniversitySchoolofMedicine SunnybrookandWomen’sCollegeHealthSciencesCentre Stanford,CA,USA Toronto,Ontario,Canada SheilaE.Cohen,MB,ChB,FRCA VictorF.Huckell,MD ProfessorofAnesthesiaandofObstetricsandGynecology ClinicalProfessorofMedicine DepartmentofAnesthesia UniversityofBritishColumbia StanfordUniversitySchoolofMedicine Vancouver,BC,Canada Stanford,CA,USA EthanJackson,MD ChantalCrochetiere,MD,FRCPC ClinicalAssistantProfessorofCardiothoracicAnesthesia AssistantProfessor DirectorofIntraoperativeTransesophagealEchocardiography, UniversityofMontre´al andDivisionChiefofAdultCongenitalCardiothoracicAnesthesia DepartmentofAnesthesiology StanfordUniversityMedicalCenterand Sainte-JustineHospital LucillePackardChildren’sHospitalatStanfordUniversity. CheminCoˆte-Ste-Catherine Stanford,CA,USA Montre´alQC,Canada HectorJ.Lacassie,MD EdwardT.Crosby,MD,FRCPC AssociateProfessor DepartmentofAnesthesiology AnesthesiologyDepartment OttawaHospital–GeneralCampus PontificiaUniversidadCato´licadeChileand Ottawa,Ontario,Canada VisitingAssociate,DukeUniversityMedicalCenter Durham,NC,USA M.JoanneDouglas,MD,FRCPC DepartmentofAnesthesia GabrielaRochaLauretti,MD,PhD BCWomen’sHospital ProfessoraAssociada(Anestesiologista) Vancouver,Canada UniversidadedeSa˜oPaulo FaculdadedeMedicinadeRibeira˜oPreto AndreaJ.Fuller,MD Av.Bandeirantes NorthernColoradoAnesthesiaProfessionalConsultants Ribeira˜oPreto-SP,Brasil StaffPhysician FortCollins,CO,USA J.Martinez-Tica,MD AssociateProfessor DepartmentofAnesthesiology UniversityofTexasMedicalBranch Galveston,TX,USA vii Listofcontributors RobertS.F.McKay,MD FelicityReynolds,MBBS,MD,FRCA,FRCOGadeundem ClinicalProfessorandChair EmeritusProfessorofObstetricAnaesthesia DepartmentofAnesthesiology StThomas’sHospital UniversityofKansasSchoolofMedicine–Wichita London,UK Wichita,KS,USA KerriM.Robertson,MD J.M.Mhyre,MD AssociateClinicalProfessor RobertWoodJohnsonClinicalScholar Chief,GVTCCMDivision Lecturer,DepartmentofAnesthesiology Chief,LiverTransplantation DivisionofObstetricalAnesthesiology DepartmentofAnesthesiology DukeUniversityMedicalCenter HollyA.Muir,MD Durham,NC,USA ViceChairClinicalOperationsDepartmentofAnesthesiology Chief,DivisionofWomen’sAnesthesia JohnE.Schlicher,MD,FAAD DukeUniversityMedicalCenter PrivatePracticeDermatologist Durham,NorthCarolina,USA BeatriceKellerClinic SunCityWest,AZ,USA M.J.Paech,MB SchoolofMedicineandPharmacology K.Scott,BM,FRCA TheUniversityofWesternAustralia SpecialistRegistrarinAnaesthesia DepartmentofAnaesthesiaandPainMedicine OxfordRadcliffeHospitalsNHSTrust KingEdwardMemorialHospitalforWomen Oxford,UK Subiaco,WesternAustralia BhadreshShah,MB,BS,MD TimothyJ.G.Pavy,MBBS,FANZCA,FRCA,FFPMANZCA,DA,DIP, FellowinObstetricalAnesthesia MID,COG SunnybrookandWomen’sCollegeHealthSciencesCentre StaffSpecialistAnaesthetistandHeadofDepartment Toronto,Ontario,Canada DepartmentofAnaesthesiaandPainMedicine KingEdwardMemorialHospital ShivK.Sharma,MD,FRCA,Professor Subiaco,WesternAustralia DepartmentofAnesthesiologyandPainManagement ObstetricDivision JohnPhilip,MD,AssociateProfessor UniversityofTexasSouthwesternMedicalCenter DepartmentofAnesthesiologyandPainManagement Dallas,TX,USA UniversityofTexasSouthwesternMedicalCenter Dallas,TX,USA MichaelSmith,MD ChiefResidentinAnesthesiology L.S.Polley,MD DepartmentofAnesthesiology AssociateProfessorofAnesthesiology UniversityofKansasSchoolofMedicine–Wichita Director,ObstetricAnesthesiology Wichita,KS,USA UniversityofMichiganHealthSystem F3900MottChildren’sHospital JeanE.Swenerton,MD,FRCPC AnnArbor,MI,USA ClinicalAssociateProfessor DivisionofObstetricAnesthesia RoannePreston,MD,FRCPC FacultyofMedicine DepartmentofAnesthesia TheUniversityofBritishColumbia BCWomen’sHospital Canada Vancouver,BC,Canada R.B.Vadhera,MD,FRCA,FFARCSI EmilyF.Ratner,MD,DABMA Director,OBAnesthesia AssociateProfessor DepartmentofAnesthesiology Co-Director,DivisionofMedicalAcupuncture UniversityofTexasMedicalBranch DepartmentofAnesthesia Galveston,TX,USA StanfordUniversitySchoolofMedicine Stanford,CA,USA viii PREFACE TO THE SECOND EDITION It has been almost ten years since the first edition of Obstetric ThisbookisdedicatedtomywifeKimberleyandchildren Anesthesia and Uncommon Disorders was published. Over the Carwyn,Jake,andSamantha. DavidR.Gambling past few years colleagues have asked the editors when they Thisbookisdedicatedtomyfamily:mymother,Bill,Matthew, couldexpecttoseeanewedition.Wehadsomehesitation,not Sheila,Erin,andMark,whofillmylifewithjoy. leastofwhichwasbecausewefeltthatmanypractionerscould M.JoanneDouglas findmostofthisinformationforthemselvesusingtheinternetor subspecialtyjournals.Uponreflection,werecognizedthatthere Wededicatethisbooktothemanyanesthesiologistswhowork isnosubstituteforatextbookthatcontainsinformationgathered longhourstoprovidesafecaretomothersandbabies,andtotheir andcarefullyreviewedbyanumberofdevotedspecialists.Hence, familieswhomakethesacrificesthatallowtheirlovedoneto spurredonbythoserequestsforasecondeditionitwasdecided providethiscare.ThankyouSusan,Lindsey,andKatie. to create a revision that provides more recent references and RobertS.F.McKay reflects some of the changes in obstetric anesthesia practice TothememoryofDrCliveMeintjiesawonderfulfriend,mentor that have occurred over the past ten years. With the assistance anddoctor. ofathirdeditor,RobertS.F.McKay,werecruitedsomeoutstand- ingnewcontributorsfromaroundtheworldandcreatedasecond editionthatwetrustthereaderwillfinduseful.Wehavecontin- uedtousechaptersbasedonbodysystemsanddiseases.Wehave consolidated some chapters, split others, and added two new chapters, namely ‘Chronic pain inpregnancy’ and ‘Malignancy andpregnancy’.Therearenow23chapterseachillustratedwith figures,tables,andphotographs,andeachchapterisaccompa- niedbyacomprehensivelistofupdatedreferences. Wethankournewpublishers,CambridgeUniversityPress,for givingustheopportunitytoproducethisrevision,andwewould liketothankeachandeverycontributorfortheirhardworkand commitmenttothisproject. Finally,wewanttothankourfamiliesfortheirpatiencewhile wespenthours,toonumeroustocount,finetuningeachchapter. ix