The Use of Epidural Analgesia for Delivery in a Patient with Pulmonary Hypertension

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Abstract
In a patient with severe pulmonary hypertension, hemodynamic observations, including cardiac output and pressure measurements in the systemic and the pulmonary circulation, were performed during vaginal delivery under selective segmental epidural block from T9 to L1 combined with bilateral pudendal blocks. No hypotensive episodes were observed in connection with the epidural block, but a gradual increase in the pulmonary pressures was observed during the stages of delivery. After perineal analgesia was achieved with bilateral pudendal blocks, a 2100-g girl with a 1-min Apgar score of 9 was delivered by vacuum extraction. The patient died 9 days after the delivery because of intractable cardiac failure.