Successful maternal outcome after vaginal delivery in a patient with Eisenmenger Syndrome
Keywords:Eisenmenger syndrome, Management, Pregnancy
Patients with Eisenmenger syndrome are advised against pregnancy. Sometimes patients are diagnosed with Eisenmenger syndrome for the first time during pregnancy. This is what has happened in our case. A primigravida was diagnosed with ventricular septal defect with severe pulmonary artery hypertension for the first time during pregnancy at 34 weeks period of gestation. Management of such patients is challenging with different studies showing variable results. Here we describe such a case which was managed conservatively and was allowed to go into labour spontaneously with vacuum extraction during second stage which subsequently led to a favourable maternal outcome.
Barst RJ, McGoon MD, Torbicki A, Sitbon O, Krowka M, Olschewski H, et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2004;43:40S-47S.
Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol. 1998;31:1650-7.
Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C. ESC guidelines on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology. Eur Heart J. 2011;32:3147-97.
Galiè N, Hoeper MM, Humbert M. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2009;30:2493-537.
Thorne S, McGregor A, Nelson-Piercy C. Risk of contraception and pregnancy in heart disease. Heart. 2006;92:1520-5.
Pieper PG. Pre-pregnancy risk assessment and counseling of the cardiac patient. Neth Heart J. 2011;19:477-81.
Oakley C, Child A, Jung B, Presbitero P, Tornos P, Klein W, et al. Expert consensus document on management of cardiovascular diseases during pregnancy. Eur Heart J. 2003;24:761-81.
Roguin N, Du ZD, Barak M, Nasser N, Hershkowitz S, Milgram E. High prevalence of muscular ventricular septal defect in neonates. J Am Coll Cardiol. 1995;26:1545-8.
Sands AJ, Casey FA, Craig BG, Dornan JC, Rogers J, Mulholland HC. Incidence and risk factors for ventricular septal defect in “low risk” neonates. Arch Dis Child Fetal Neonatal Ed. 1999;81:F61-3.
Hiraishi S, Agata Y, Nowatari M. Incidence and natural course of trabecular ventricular septal defect: two-dimensional echocardiography and color Doppler flow imaging study. J Pediatr. 1992;120:409-15.
Ooshima A, Fukushige J, Ueda K. Incidence of structural cardiac disorders in neonates: an evaluation by color Doppler echocardiography and the results of a 1-year follow-up. Cardiol. 1995;86:402-6.
Du ZD, Roguin N, Barak M, Bihari SG, Ben-Elisha M. High prevalence of muscular ventricular septal defect in preterm neonates. Am J Cardiol. 1996;78:1183-5.
Du ZD, Roguin N, Wu XJ. Spontaneous closure of muscular ventricular septal defect identified by echocardiography in neonates. Cardiol Young. 1998;8:500-5.
Madden BP. Pulmonary hypertension and pregnancy. Int J Obstet Anesth. 2009;18:156-64.
Hsu CH, Gomberg-Maitland M, Glassner C. The management of pregnancy and pregnancy-related medical conditions in pulmonary arterial hypertension patients. Int J Clin Pract. 2011;65(172):6-14.
Weiss BM, Hess OM. Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives. Eur Heart J. 2000;21:104-15.
Uebing A, Steer PJ, Yentis SM, Gatzoulis MA. Pregnancy and congenital heart disease. Br Med J. 2006;332:401-6.
Warnes CA. Pregnancy and pulmonary hypertension. Int J Cardiol. 2004;97(1):11-3.
Metcalfe J, Ueland K. Maternal cardiovascular adjustments to pregnancy. Prog Cardiovasc Dis. 1974;16:363-74.
Pieper PG, Hoendermis ES. Pregnancy in women with pulmonary hypertension. Neth Heart J. 2011;19:504-8.
Kalra P. Vaginal delivery in a patient of Eisenmenger syndrome. Indian J Med Sci. 2012;66:289-91.
Avila WS, Grinberg M, Snitcowsky R, Faccioli R, Da Luz PL, Bellotti G, et al. Maternal and fetal outcome in pregnant women with Eisenmenger's syndrome. Eur Heart J. 1995;16:460-4.
Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circ. 2001;104:515-21.
Steer PJ. Pregnancy and contraception. In: Gatzoulis MA, Swan L, Therrien J, Pantely GA, editors. Adult congenital heart disease: a practical guide. Oxford: BMJ, Blackwell; 2005:16-35.