Vaginal delivery in a patient with asymptomatic severe aortic stenosis: a case report

Authors

  • Kanagavarshani M. Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
  • Amanjot Kaur Department of Obstetrics and Gynecology, PGIMER Chandigarh, India
  • Pooja Sikka Department of Obstetrics and Gynecology, PGIMER Chandigarh, India
  • Neelam Aggarwal Department of Obstetrics and Gynecology, PGIMER Chandigarh, India
  • Seema Chopra Department of Obstetrics and Gynecology, PGIMER Chandigarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20232157

Keywords:

Valvular heart diseases, Ejection fraction, Severe asymptomatic aortic stenosis, Pregnancy, Vaginal delivery, Aortic stenosis

Abstract

Heart disease complicates about 1-4% of all pregnancies of which valvular heart disease is the commonest cause. In developing countries, congenital heart diseases are commonly first detected during pregnancy. Most women do well during pregnancy but severe mitral stenosis or severe aortic stenosis are high-risk conditions that can cause significant morbidity and mortality. Unlike asymptomatic severe mitral stenosis, asymptomatic severe aortic stenosis is mWHO category 3. There is no consensus on the mode of delivery in patients with asymptomatic severe aortic stenosis. Here we describe a case of successful vaginal delivery in a woman with severe aortic stenosis. As the patient was asymptomatic and ejection fraction was preserved, a joint decision for vaginal delivery was taken along with the cardiology team. The patient was induced and delivered with operative vaginal delivery. This case shows that vaginal delivery could be a viable option in patients with asymptomatic severe aortic stenosis given continuous haemodynamic monitoring can be provided.

References

Reimold SC, Rutherford JD. Valvular Heart Disease in Pregnancy. N England J Med. 2003;2.

Nishimura RA, Otto CM, Bonow RO. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease. J Am College Cardiol. 2014;63:57-185.

Kumari A, Kumar K, Sinha A. The Pattern of Valvular Heart Diseases in India During Pregnancy and Its Outcomes. Cureus. 2021;1.

Fedak PW, Verma S, David TE. Clinical and Pathophysiological Implications of a Bicuspid Aortic Valve. Circulation. 2000;106:900-4.

Siu SC, Colman JM. Congenital heart disease: Heart disease and pregnancy. Heart. 2001;85:710-15.

Thorne S. Pregnancy and native heart valve disease. Heart. 2016;102:1410-17.

Driul L, Meroi F, Sala A. Vaginal delivery in a patient with severe aortic stenosis under epidural analgesia, a case report. Cardiovascular Ultrasound. 2018;18.

Ruys TP, Roos-Hesselink JW, Pijuan-Domenech A. Is a planned caesarean section in women with cardiac disease beneficial? Heart. 2006;101:530-6.

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Published

2023-07-11

Issue

Section

Case Reports