Epidural analgesia for a 36-week parturient with severe mitral stenosis and pulmonary edema for spontaneous vaginal delivery

A 26 year old near-term pregnant patient with severe mitral stenosis and pulmonary edema presented to us with labor pain. After starting her on oxygen, diuretics, we provided labor analgesia with a combination of low-dose epidural local anesthetics with fentanyl. The conduct of the delivery was uneventful. We recommend the use of labor analgesia to attenuate the response of pregnancy and labor on the cardiovascular system, especially in parturients with valvular disease like mitral stenosis. We also state that a multidisciplinary approach is necessary in handling such sick parturients.