Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 6 ( November-December, 2022 ) > List of Articles


Pregnancy with Eisenmenger's Syndrome

Snehal Shivaji Shinde, Shweta Avinash Khade, Smurti Kamble, Archana Anilkumar Bhosale, Arun Harishchandra Nayak

Keywords : Eisenmenger's syndrome in pregnancy, High-risk pregnancy, Maternal and fetal outcome in pregnancy with Eisenmenger's syndrome, Maternal mortality, Pregnancy with heart disease, Severe PAH in pregnancy

Citation Information : Shinde SS, Khade SA, Kamble S, Bhosale AA, Nayak AH. Pregnancy with Eisenmenger's Syndrome. J South Asian Feder Obs Gynae 2022; 14 (6):753-754.

DOI: 10.5005/jp-journals-10006-2148

License: CC BY-NC 4.0

Published Online: 31-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: This case report is aimed at studying the maternal and foetal outcome in pregnancy with congenital heart disease complicated with Eisenmenger's syndrome (ES). Background: Eisenmenger's syndrome is the presence of a reversed or bi-directional shunt at the aortopulmonary, interatrial, or interventricular level along with pulmonary artery hypertension (PAH). This causes severe maternal hypoxemia and life-threatening complications. Case description: We report a rare case of 31-year-old primigravida with 34 weeks gestation diagnosed with congenital heart disease complicated with ES for the first time in the index pregnancy. On evaluation for her breathlessness at 34 weeks gestation, she was found to have a 23 mm ostium secundum ASD with bidirectional shunt with severe pulmonary artery hypertension with PASP of 155 mm Hg. Her pregnancy was further complicated with gestational thrombocytopenia and intrauterine growth restriction (IUGR). She was managed by a multidisciplinary team at our tertiary care center with sildenafil (vasodilator), diuretics, oxygen therapy, antenatal steroids and ultrasound obstetric Doppler surveillance for IUGR. She underwent an emergency caesarean section under epidural anesthesia at 35 weeks gestation in view of breech presentation in preterm labor. Postoperatively she was monitored closely in cardiac ICU for 3 days and later shifted to ward. She was then discharged 2 weeks later with same medications continued and advice regarding need for cardiac follow-up and contraception in order to avoid future pregnancies. Conclusion: Eisenmenger's syndrome in pregnancy is associated with a high maternal morbidity and mortality. The ES patient with PAH should be monitored closely and managed in a tertiary facility with a multidisciplinary teamwork if they choose to continue their pregnancy for a favorable maternal and foetal outcome as in our case. Clinical significance: Pregnancy is best avoided in patients with ES on account of very high maternal and fetal morbidity and mortality. Successful maternal and fetal outcome of pregnancies complicated with ES needs thorough management by multidisciplinary teamwork in a tertiary facility.

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