19 years old primigravida presented at 28 weeks’ gestation to herroutine antenatal clinic appointment in Benha University Hospitals complainingof chest tightness and shortness of breath.
Her pulse was irregular andreaching 130bpm. Otherwise her other vital signs were stable. Abdominalexamination revealed soft and lax gravid uterus with fundal heightcorresponding to her dates and audible foetal heart beat.
There was goodperception of foetal kicks and no gush of fluid or vaginal bleeding. Herultrasound showed single living healthy foetus with to date biometric andDoppler parameters.The woman was referred immediately to emergency unit where she wasreviewed by senior cardiologist. Initially, her electrocardiography was showingno abnormalities, but her echocardiography discovered the presence ofnon-mobile atrial septal aneurysm towards the right side without visiblethrombosis or shunt at the trans-thoracic echocardiogram level. Her atrialdimension, ventricular dimensions, valves were normal and no segmental wallmotion abnormalities could be detected at rest. Beta-blockers and aspirin wereprescribed to the woman. There was a strong family history of cardiac lesionsand she had a sister who died from congenital heart defect.
The pregnant lady was followed up on weekly outpatient basis as a highrisk case. Her echocardiography was repeated at monthly intervals. At 36 weeks’gestation, it showed extra findings as prolapsed anterior mitral valve leafletwith moderate to severe mitral regurgitation was detected with normal othervalves. Also, her left ventricular dimensions were dilated with mild systolicdysfunction.
The recommendations by cardiologist included that as long as shewas haemodynamically stable and showed no signs of arrhythmias or thrombosis,she can go for spontaneous vaginal delivery or caesarean section according toobstetric decision with appropriate timing and dose of thromboprophylaxis. Aspirinwas stopped at the same visit. Senior anaesthetist carefully reviewed the case and decided that she iscandidate for general or regional anaesthesia whenever needed and applicable.She was delivered by caesarean section at 39 weeks’ gestation as she started tohave labour pains and progressive cervical dilatation with breech presentation.Her postoperative follow-up was uneventful and she was discharged home on daythree after the procedure. Thromboprophylaxis started 12 hours postoperativeand continued till six weeks postpartum.
After puerperium she started to followup with cardiology clinic.