Labour analgesia and anaesthetic management of a primigravida with uncorrected Pentology of Fallot

Tetraology of Fallot is the most common congenital heart disease causing intracardiac right-left shunts. It is characterized by presence of ventricular septal defect, aortic overriding, pulmonary artery outflow obstruction and right ventricular hypertrophy. When these features are associated with atrial septal defect, it is often referred to as Pentology of Fallot (POF). If the lesions remain uncorrected, they can cause significant morbidity and mortality to the patient. Pregnancy and labour in such a patient present with significant haemodynamic changes, which can be challenging to the anaesthesiologist. Our patient with POF was managed with labour analgesia and subsequently epidural anaesthesia for drainage of vulval haematoma with successful outcome.