Background- Cardiovascular diseases with severe MS, severe AS, and pulmonary hypertension account for serious morbidity to both mother and baby

Case presentation- A 26-year-old primigravida, k/c/o RHD with severe MS, AS and pulmonary hypertension was advised to undergo cardiac intervention but did not comply. She came to the casualty at 26 weeks of gestation, with signs of CCF and threatened preterm labour. She was admitted to the cardiac ICU where she was stabilized with the help of a cardiology team, emergency cardiac medical management of cardiac failure was done. Obstetrical ultrasound revealed a single intrauterine viable pregnancy with parameters corresponding to the gestational age. With the help of multidisciplinary team of cardiologists, obstetricians, paediatricians and intensivists, risk of termination was weighed against the continuation of pregnancy till term and the same was discussed with the patient and her relatives and well curated plan was made to conserve the pregnancy till term with a plan of elective cesarean section along with a DVR consequently in a cardiac OT. During the course of this pregnancy, extensive monitoring was done with judicious use of cardiac and obstetric medicine to maintain an equilibrium between cardiac status of the mother and growth of the baby with an ultimate goal of a good fetomaternal outcome. The family was counselled about the do’s and don’ts and admitted for a week for observations till term. At 36+2 weeks of gestation, elective LSCS was done under GA with concurrent DVR. A female baby of 2.01 kg was delivered, cried immediately after birth. Intraoperative and postoperative period was uneventful .

Conclusion – Meticulous multidisciplinary approach allowed to continue a pregnancy till term in a patient with severe cardiac disease for a good fetomaternal outcome.

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