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Background <p>Cardiovascular disease with severe mitral stenosis, severe aortic stenosis, and severe pulmonary artery hypertension accounts for serious morbidity to both mother and baby. Termination of pregnancy at diagnosis is recommended by evidence-based practices.</p> Case <p>A 25-year-old primigravida, 26&#xa0;weeks of gestation k/c/o Rheumatic Heart Disease with severe MS, severe AS, and PAH with early signs of cardiac failure, was referred for termination of pregnancy and cardiac intervention. She was admitted in cardiac ICU, stabilized from cardiac failure. The risk of termination with refractory cardiac status and MTP law requirements of termination at 26&#xa0;weeks was weighed against the continuation of pregnancy1. A dynamic antenatal plan of scheduled antenatal admissions, 6-min walk test, serial 2D Echo and obstetric Doppler, medication titration to balance maternal cardiac status, and fetal growth was made. She was optimized till 36.4&#xa0;weeks of gestation and delivered female child 2010 gms by elective cesarean section with concurrent dual-valve replacement.</p> Conclusion <p>Multidisciplinary approach with experienced peripartum critical care management team is key to deliver patients with WHO risk category IV at term. Judicious titration of cardiac and obstetric medicines is required in peripartum period avoiding decompensation and fetal morbidity2. Series of cases documentation is required to standardize the treatment protocol in refractory cardiac cases.</p>

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Fetomaternal Outcome in Severe Mitral and Aortic Stenosis with Progressive Pulmonary Arterial Hypertension: Term Cesarean Section with Concurrent Dual-Valve Replacement

  • 期刊论文

  • 发表日期：

    2026年3月16日

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  • Kiran M. Rajole,
  • Vidyut Kumar,
  • Prashant Pandit Pawar,
  • Pooja Parmeshwar Asole

摘要

Background

Cardiovascular disease with severe mitral stenosis, severe aortic stenosis, and severe pulmonary artery hypertension accounts for serious morbidity to both mother and baby. Termination of pregnancy at diagnosis is recommended by evidence-based practices.

Case

A 25-year-old primigravida, 26 weeks of gestation k/c/o Rheumatic Heart Disease with severe MS, severe AS, and PAH with early signs of cardiac failure, was referred for termination of pregnancy and cardiac intervention. She was admitted in cardiac ICU, stabilized from cardiac failure. The risk of termination with refractory cardiac status and MTP law requirements of termination at 26 weeks was weighed against the continuation of pregnancy1. A dynamic antenatal plan of scheduled antenatal admissions, 6-min walk test, serial 2D Echo and obstetric Doppler, medication titration to balance maternal cardiac status, and fetal growth was made. She was optimized till 36.4 weeks of gestation and delivered female child 2010 gms by elective cesarean section with concurrent dual-valve replacement.

Conclusion

Multidisciplinary approach with experienced peripartum critical care management team is key to deliver patients with WHO risk category IV at term. Judicious titration of cardiac and obstetric medicines is required in peripartum period avoiding decompensation and fetal morbidity2. Series of cases documentation is required to standardize the treatment protocol in refractory cardiac cases.