Intrathecal morphine for relief of labor pain in a parturient with severe pulmonary hypertension

Abstract

In women who have primary pulmonary hypertension maternal mortality is more than 50% usually during labor or puerperium. The hemodynamic features of this condition consist of pulmonary artery pressure higher than 30/15 mmHg, right ventricular hypertrophy, and eventually failure and a low fixed cardiac output. Most complications arise from a decrease in systemic vascular resistance and reduction in venous return. For this reason, spinal or epidural anesthesia often is avoided in these patients. Hyperbaric morphine injected intrathecally provides excellent analgesia during labor without any significant autonomic or motor effects. We describe the labor and delivery in a patient with severe pulmonary hypertension who received intrathecal morphine analgesia.