Use of esmolol in a parturient with hypertrophic obstructive cardiomyopathy

The physiological changes occurring during pregnancy and labour may revealor exacerbate the symptoms of hypertrophic obstructive cardiomyopathy(HOCM). We describe the management of labour in a patient with severe HOCMduring which esmolol, a short-acting beta adrenergic antagonist, was usedtogether with extradural analgesia and invasive cardiovascular monitoringto achieve an assisted vaginal delivery with minimal haemodynamicdisturbance. The effects on the infant are described and the literature onthe use of esmolol in pregnancy is reviewed.