Antepartum Considerations

Patients with EDS are at increased risk for cardiac valvular disease and aortic dilatation.4  Although no standardized protocols exist for the evaluation of cardiovascular function with echocardiography in EDS, a baseline screening echocardiogram is usually performed, with follow-up studies based on the initial results or the development of new symptoms.

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Closer monitoring may be required in patients with vascular and kyphoscoliosis EDS, given the higher risk of cardiovascular diseases in these types of EDS and depending upon the severity of the illness. Particular attention should be paid to the aortic root diameter.4

Patients with joint hypermobility should be referred for physical and occupational therapy evaluation. A low-impact, muscle-strengthening program for joint protection and appropriate use of assistive devices, such as orthoses, can have a positive impact on activities of daily living.1

In patients with joint hypermobility, musculoskeletal pain may become chronic and difficult to treat. Pharmacologic treatment of joint pain involves the use of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). However, NSAIDS may diminish platelet function and generally should be avoided in patients with a history of easy bruising. This is especially true if bleeding is anticipated during labor and delivery.  Additionally, the chronic use of NSAIDs is discouraged in pregnancy when possible due to the possible increased risk of premature closure of the fetal ductus arteriosus and oligohydramnios.5

Increased ligament laxity and risk of tendon rupture are most concerning in patients during their third trimester.  

Communication with the obstetric labor and delivery team, the anesthesia providers, and the newborn pediatric team is crucial. The availability of cross-matched blood, especially in patients with higher risk of postpartum bleeding, should be considered prior to surgery due to potential fragility of blood vessel walls.6

Patients with EDS can have symptoms of esophagitis and gastroesophageal reflux (GERD); these should be addressed prior to delivery to minimize risk of aspiration while the patient is positioned for vaginal or Cesarean section delivery. 

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