[Continuous epidural analgesia with intensive monitoring of cardiovascular system for vaginal delivery in a patient with Marfan's syndrome].

We report here the management of labor for a 33-year-old woman with Marfan's syndrome. She was diagnosed as Marfan's syndrome at the age of 5 and experienced corrective surgery for abdominal aortic aneurysm at 28 years of age. As there was no progression of cardiovascular lesion, she was allowed to be pregnant. She was planned to proceed with vaginal delivery, since she was in trouble of circulation during her gestational period. In order to prevent catastrophe such as aortic dissection or aortic regurgitation elicited by hypertension related with labor pain, we performed continuous epidural anesthesia to control labor pain under the invasive blood pressure monitoring. Two epidural catheters were inserted into the epidural space via the L 2-3 and the L 5-S 1 intervertebral space, and mixed solutions containing both 0.125% bupivacaine and 0.0002% fentanyl were administered continuously. After 7 hours and 47 minutes from the start of her labor, she delivered her baby vaginally with the aid of forceps technique due to attenuated abdominal muscle activity. No cardiovascular mishaps occurred during her labor and she was discharged 6 days after the delivery. Thus, continuous epidural anesthesia with intensive monitoring of circulation may be useful for vaginal delivery in a patient with Marfan's syndrome by avoiding cardiovascular complications due to labor pain.