Challenges in anesthetic management of an obstetric patient with dilated cardiomyopathy and multiple organ dysfunction posted for emergency cesarean section: A case report

Abstract

The prevalence of dilated cardiomyopathy (DCM) is 1:2500 among women of childbearing age. DCM often develops during the second trimester or may be present before pregnancy. We present a 36-year-old gravida (G3, P0+2) coming to the emergency ward with severe breathlessness, pedal edema, oliguria, and absent fetal movements at 36 weeks 3 days gestational age. Emergency cesarean section was performed under general anesthesia while supporting the hemodynamic parameters with inotropes intraoperatively. The patient was shifted to the intensive care unit for further monitoring and cardiac stabilization. This case report illustrates the anesthetic challenges during emergency cesarean section of a gravid patient with DCM with multiple organ dysfunction and its successful outcome. Echocardiography is an essential utility for monitoring cardiac function, especially in patients presenting with a left ventricular ejection fraction <30%. Advanced maternal clinical outcomes improve substantially with early systemic diagnosis, regular follow-ups, and planned institutional deliveries.