A CLINICAL CASE OF IDIOPATHIC PULMONARY HYPERTENSION DURING PREGNANCY

Objective. To present a clinical case of management in a pregnant woman with idiopathic pulmonary hypertension (PH) Case: Patient K. aged 31 years was transferred to the V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology from her domicile perinatal center with for new-onset PH to decide further management tactics and delivery time. Progressive edema and leg edemas were noted at 20 weeks gestation. Worse health could be caused by the fact that the woman with chronic autoimmune thyroiditis and hypothyroidism stopped taking thyroxine at 14 weeks gestation. The diagnosis was established at her local polyclinic at 29—30 weeks gestation. On admission, the patient’s condition was severe, which was induced by significant respiratory failure. The data of her examination and laboratory and instrumental studies could diagnose that she was 33—34 weeks pregnant and had fetal cephalic presentation, severe pulmonary hypertension, NYHA FC IV. The patient underwent emergency surgical delivery. In the postpartum period, she was treated with fraxiparine 0.6 ml/day, furosemide 40 mg/day under control of diuresis and blood electrolytes, and amlodipine 1.25 g b.i.d., which was then titrated up or down in 1.25 g increments every 7 days. A calcium antagonist was used without performing a vasoreactive test as right heart catherization was possible only after achieving thyroid compensation. For this, the patient was given euthyrox 200ig/day. Results. A premature baby was born with a weight of 1955g and the signs of pneumonia, jaundice, and transient hypothyroxinemia, which required special care, massive drug therapy, and long-term follow-up. The woman’s postpartum condition remained stable. On day 3 of delivery, the patient was transferred to her domicile perinatal center and recommended to continue the started treatment and to replace low-molecular-weight heparin by warfarin under control INR. She was recommended be examined by a cardiologist at the A.L. Myasnikov Research Institute of Clinical Cardiology 6-8 weeks later. Conclusion. Thus, PH is a pathological condition incompatible with pregnancy. The signs of severe cardiac and respiratory failure in HP, a high risk for death and cardiovascular and thromboembolic events, and a need for active medicinal intervention require that pregnancy should be terminated in any period. The multidisciplinary approach to pregnancy management and clinical alertness allow timely diagnosis and prevention of maternal and fetal complications.

pulmonary hypertension, pregnancy