Sitting around the table were a cluster of maternal fetal medicine obstetricians, a gaggle of cardiologists and a troop of nurses from across the hospital. An obstetric anesthesiologist and a critical care anesthesiologist joined the fray. At the center of the discussion was a 26-year-old parturient with a complex history of congenital heart disease. She was 32 weeks pregnant and had pulmonary hypertension on continuous I.V. prostacyclin.

Critically ill obstetric patients are becoming increasingly common. This may be in part due to the increasing age and changes in maternal health as well as specific efforts to improve maternal morbidity and mortality. Some of these efforts include improved surgical and medical management of patients with congenital disease, thereby increasing the number of patients in the reproductive stage. In response to a complex patient population and rising maternal...

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