Anaesthetic management for caesarean section in a patient with hereditary haemorrhagic telangiectasia and severe epistaxis during pregnancy

Article Article scientifique Rapport de cas Anaesthetic management for caesarean section in a patient with hereditary haemorrhagic telangiectasia and severe epistaxis during pregnancy eng 2023-10-03 2023-10-03 author Fogang D. Claudie Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland. author Martin-Salvaj Gallice Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland. 68669 author Boehlen Françoise Division of Angiology and Hemostasis, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.,University of Geneva, Faculty of Medicine, Geneva, Switzerland. 33004 author Savoldelli Georges Louis 0000-0002-8968-6920 Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland Georges.savoldelli@hcuge.ch.,University of Geneva, Faculty of Medicine, Geneva, Switzerland. 41344 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) e255530 10.1136/bcr-2023-255530 37788916 1757-790X PMC10551871 https://casereports.bmj.com/content/16/10/e255530.long A primigravida patient, with a history of hereditary haemorrhagic telangiectasia (HHT) manifesting as nasal angiodysplasia and hepatic arteriovenous malformations (AVM), presented for delivery planning and anaesthetic evaluation at 29 weeks of gestation. She was hospitalised several times during the second and third trimester for serious recurrent epistaxis, leading to severe anaemia. In total, she required the transfusion of 20 units of packed red blood cells during her pregnancy as well as surgical nasal haemostasis under general anaesthesia (GA). The patient was referred to our tertiary centre for delivery. In the context of recurrent severe epistaxis and high cardiac output (due to hepatic AVM) in the third trimester, a multidisciplinary decision was made to plan an elective caesarean section at 35 4/7 weeks combined with nasal packing under GA. This report discusses the implications of HHT, the multidisciplinary planning of the caesarean section, intraoperative anaesthetic management and patient follow-up. Anaesthesia Ear, nose and throat/otolaryngology Haematology (incl blood transfusion) Pregnancy Humans Female Telangiectasia, Hereditary Hemorrhagic / complications Epistaxis / etiology Epistaxis / surgery Cesarean Section Pregnancy Trimester, Third Hemangioma Anesthetics Dewey 616 Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 56 Département de médecine 221 false 538 Groupe Savoldelli Georges (simulation) 878 BMJ case reports 16 10 61f86fea-1049-4366-8e38-172ff9839156 Article (Published version) Public Article_scientifique_from_europePmc.pdf 1007792 application/pdf CC BY-NC-4.0 1dadb10f79c7f3b176f1005bf367002a5debb18de6a8cac1837f6e674059d291 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences Faculté de médecine / Section de médecine clinique / Département de médecine

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Anaesthetic management for caesarean section in a patient with hereditary haemorrhagic telangiectasia and severe epistaxis during pregnancy	BMJ case reports			2023	30	102

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