Emergency Caesarean Section in Systemic Sclerosis: Multidisciplinary Management

Abstract

Systemic sclerosis (Ss) is a rare autoimmune disease, it is associated with abnormal deposition of extracellular collagen in visceral organs and skin. Another feature of Systemic sclerosis is vascular dysfunction, causing distal amputation secondary to multiple Raynaud’s Phenomenon. Ss it is an anaesthetic challenge from different point of views, patients usually show poor oral aperture and consequently difficult airway management. Moreover they may even be affected by restrictive pulmonary disease, representing an obstacle for adequate mechanical ventilation. Ss it is also associated with cardiovascular and respiratory comorbidities. Management of systemic sclerosis involved many different specialties such as: paediatrician and gynecologist who gave 32 weeks of pregnancy as an acceptable moment to perform caesarean delivery if needed. Also thoracic surgeon was engaged to help us in managing difficult airways by flexible bronchoscopy if general anesthesia would have been necessary. Patients affected by Ss, are usually young woman, so we should expect to manage pregnancy in this rare pathology also because the immunosuppressant therapies are more effective now than in the past. In this case report, a pregnant women affected by Ss was managed even in emergency situation. In order to reduce mistake and to manage any possible condition such as elective caesarean section or emergency one, we decided to adopt an anesthesiologic protocol to manage our patient. Our protocol established three attempt for each anesthesia technique, first line anesthesia was epidural anesthesia, then spinal anesthesia and as last chance general anesthesia. As a result of non-reassuring fetal heart rate, patient underwent an emergency caesarean section, we had to perform spinal anesthesia because it was difficult to place epidural catheter. Patient was stable after spinal anesthesia and surgery, so our case report strongly recommends to plan carefully anesthesia, in this case spinal anesthesia is a viable solution for women with Scleroderma undergoing caesarean section.