EPIDURAL ANALGESIA FOR LABOR IN A PATIENT WITH EBSTEINS-ANOMALY

Ebstein's anomaly is an uncommon congenital cardiac defect which is as sociated with cyanosis and arrhythmias. There have been very few previ ous reported cares of successful outcome in pregnancy in women with th is disorder. We describe the successful analgesic management gi an obs tetric patient who had been known to have Ebstein's anomaly since chil dhood. Her first pregnancy was uneventful and analgesia during labour was provided by an epidural. During her second pregnancy she presented to our hospital as her condition had deteriorated Symptomatic control was achieved with digoxin. Despite this, several episodes of hospital ization were needed pre-partum for rest and oxygen therapy. After the onset of spontaneous labour, analgesia was managed by an epidural usin g bupivacaine. Invasive monitoring was nor deemed appropriate due to i ncreased risk and questionable usefulness. Vaginal delivery was manage d with elective lift-out forceps to minimize the stress of pushing. Wh en reviewed two months post-partum site still required di goxin althou gh her symptoms had improved considerably. The successful management o f Ebstein's anomaly in pregnancy should include team management from e arly in pregnancy.