Anesthetic Management for Elective Cesarean Section in a Pregnant Woman With Hypertrophic Obstructive Cardiomyopathy and a Marked Family History: A Case Report Focusing on Efficient Hemostasis Using Fibrinogen Concentrate

Anesthetic management for cesarean section (CS) in patients with hypertrophic obstructive cardiomyopathy (HOCM) requires strict hemodynamic control.A 32-year-old pregnant woman with HOCM, whose mother had died of HOCM and postpartum hemorrhage following CS, was scheduled for an elective CS.Combined spinal-epidural anesthesia was performed with a continuous norepinephrine infusion.Pre-induction echocardiography confirmed the improvement of left ventricular outflow tract (LVOT) obstruction following volume loading.During intraoperative skin-to-skin contact, an infusion failure caused transient hypotension, which was promptly detected via continuous arterial pressure monitoring and corrected.Postoperatively, the patient developed postpartum hemorrhage with pre-disseminated intravascular coagulation (pre-DIC).To rapidly correct severe hypofibrinogenemia and break the bleeding cycle, fibrinogen concentrate was prioritized, while fresh frozen plasma (FFP) was combined for comprehensive coagulation factor replenishment and hypovolemia management.Postoperative atrial fibrillation (AF) was resolved with intravenous amiodarone, and she was discharged on postoperative day (POD) 16.In high-risk patients with HOCM, dynamic strategies integrating real-time cardiac assessment, targeted coagulation factor replacement, and continuous arterial pressure monitoring may contribute to successful anesthetic management.