Coarctation of Aorta and pregnancy – troublesome association with good outcome–case report

Abstract

A 34 year old pacient with 2 previous abortions spontaneously obtain a sigle intrauterine pregnancy. She is having a coarctation of aorta and persistent ductus arteriosus surgicaly corrected in childhood with persistent gradient of 30 mmHg on aortoplasty site evaluated by ultrasound. Previous abortions were one spontaneous at 10 weeks and one for high risk for fetal cardiovascular malformation at 13 weeks and 3 days. First trimester blood, urine, virology and genetic risk investigations were all normal. From 18 weeks of pregnancy the patient started to develop fatigue and short of breath upon previously tolerated effort. Blood Pressure was sometimes raised on clinical consultation. Despite medication (metoprolol twice daily) symptoms persisted. On ambulatory monitoring of BP there were rises up to 250/130 mmHg on effort, reluctant to medication in usual doses. On 23 weeks BP peaks appeared on minimal effort (public transportation from an to medical facility). All blood and urine tests performed were normal. Bed rest and alpha-metil-dopa supplement 1/2 hour before expected minimal effort successfully maintained BP below 150/90 mmHg with night as low as 90/50 mmHg. With bed rest pregnancy evolved with no medical problems until 39 weeks and 3 days when was performed a cesarian section on onset of labor for maternal safety reason. Baby girl 3230 gr. APGAR 9 and a a joyous family did make it worth all troublesome.