A case series of pregnancy in eisenmenger's syndrome- a management conundrum

Eisenmenger's syndrome(ES) refers to the development of pulmonary hypertension and reversal of shunt in patients with long standing congenital heart defects with left-to-right shunt. The cardiovascular changes in pregnancy, labour and puerperium add to the morbidity and mortality associated with this high-risk cardiac condition. Fetal outcome is also poor with increased incidence of stillbirth and prematurity. We report 3 such patients of ES with severe pulmonary hypertension. The rst patient presented in advanced pregnancy with unbooked status. She had a spontaneous preterm precipitate labour before cardiac optimization and delivered vaginally with successful outcome. The second patient presented to us in early third trimester with right heart failure, which was stabilized after caesarean section. The third patient also had a good outcome, despite additional complications of pulmonary edema. Neonatal outcome in our case series was marred by complications like fetal growth restriction, prematurity, perinatal asphyxia and one neonatal death. A multidisciplinary team approach involving obstetric medicine specialists, cardiologists, anaesthesiologists and neonatologists, is required for peripartum care of these patients to improve the maternal and perinatal outcomes.