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Pregnancy in Eisenmenger syndrome: a case series from a tertiary care hospital of Northern India

Published online by Cambridge University Press:  05 January 2023

Bharti Sharma Open the ORCID record for Bharti Sharma [Opens in a new window] ,
Pooja Sikka Open the ORCID record for Pooja Sikka [Opens in a new window] ,
Seema Chopra ,
Ramandeep Bansal ,
Vanita Suri ,
Neelam Aggarwal ,
Subhas C. Saha ,
Rajesh Vijayvergiya ,
Ishwar Bhukal  and
Praveen Kumar
Bharti Sharma*
Affiliation:
Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Pooja Sikka
Affiliation:
Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Seema Chopra
Affiliation:
Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Ramandeep Bansal
Affiliation:
Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Vanita Suri
Affiliation:
Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Neelam Aggarwal
Affiliation:
Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Subhas C. Saha
Affiliation:
Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Rajesh Vijayvergiya
Affiliation:
Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Ishwar Bhukal
Affiliation:
Department of Anesthesiology & Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Praveen Kumar
Affiliation:
Department of Pediatrics (Neonatology Unit), Post Graduate Institute of Medical Education and Research, Chandigarh, India
*
Author for correspondence: Dr B. Sharma, DGO, DNB, Consultant (WHO SEAR Project), Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. Tel: +0172 2756331. E-mail: drbharti22@gmail.com
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Abstract

Background:

Despite advances in medical care, we still come across pregnancy in Eisenmenger syndrome. Eisenmenger syndrome represents the severe end of the spectrum for disease in pulmonary artery hypertension associated with CHD. Due to very high maternal and perinatal morbidity and mortality, pregnancy is contraindicated among these women. Current guidelines also recommend that the women who become pregnant should opt for early termination of pregnancy. Here, we present a case series of 11 women of Eisenmenger syndrome and their pregnancy outcome.

Methods:

It was a retrospective analysis of 12 pregnancies among 11 women with Eisenmenger syndrome who were managed in a tertiary care referral centre of Northern India.

Results:

The mean age of these women was 28 ± 4 years (range 22 to 36 years). Almost 80% of them (9/11) were diagnosed with Eisenmenger syndrome during pregnancy. The commonest cardiac lesion was Ventricular Septal defect (54.5%) followed by Atrial Septal defect (27.3%) and Patent Ductus arteriosus (9.1%). Only three women opted for medical termination of pregnancy, rest eight continued the pregnancy or presented late. Pregnancy complications found include pre-eclampsia (50%), abruption (22%), and fetal growth retardation (62.5%). There were three maternal deaths (mortality rate 27%) in postpartum period.

Conclusion:

This case series highlights the delay in diagnosis and treatment of CHD despite improvement in medical care. Women with Eisenmenger syndrome require effective contraception, preconceptional counselling, early termination of pregnancy, and multidisciplinary care.

Keywords

Eisenmenger syndromepregnancyCHDs
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 11 , November 2023 , pp. 2185 - 2189
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Wood, P. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. Br Med J 1958; 2: 755–762.CrossRefGoogle ScholarPubMed
Diller, GP, Gatzoulis, MA. Pulmonary vascular disease in adults with congenital heart disease. Circulation 2007; 115: 1039–1050.CrossRefGoogle ScholarPubMed
Beghetti, M, Galiè, N. Eisenmenger syndrome: a clinical perspective in a new therapeutic era of pulmonary arterial hypertension. J Am Coll Cardiol 2009; 53: 733–740.10.1016/j.jacc.2008.11.025CrossRefGoogle Scholar
Aggarwal, N, Suri, V, Kaur, H, Chopra, S, Rohilla, M, Vijayvergiya, R. Retrospective analysis of outcome of pregnancy in women with congenital heart disease: single-centre experience from North India. Aust N Z J Obstet Gynaecol 2009; 49: 376–381.CrossRefGoogle ScholarPubMed
Silversides, CK, Grewal, J, Mason, J, et al. Pregnancy outcomes in women with heart disease: the CARPREG II study. J Am Coll Cardiol 2018; 71: 2419–2430.CrossRefGoogle ScholarPubMed
Saha, A, Balakrishnan, KG, Jaiswal, PK, et al. Prognosis for patients with Eisenmenger syndrome of various aetiology. Int J Cardiol 1994; 45: 199–207.10.1016/0167-5273(94)90166-XCrossRefGoogle ScholarPubMed
Weiss, BM, Zemp, L, Seifert, B, et al. Outcome of pulmonary vascular disease in pregnancy; a systematic overview from 1978 through 1996. J Am Coll Cardiol 1998; 31: 1650–1657.10.1016/S0735-1097(98)00162-4CrossRefGoogle ScholarPubMed
van Oppen, AC, Stigter, RH, Bruinse, HW. Cardiac output in normal pregnancy: a critical review. Obstet Gynecol 1996; 87: 310–318.10.1016/0029-7844(95)00348-7CrossRefGoogle ScholarPubMed
Hemnes, AR, Kiely, DG, Cockrill, BA, et al. Statement on pregnancy in pulmonary hypertension from the pulmonary vascular research institute. Pulm Circ 2015; 5: 435–465.10.1086/682230CrossRefGoogle ScholarPubMed
Endorsed by the European Society of Gynecology (ESG), the Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 3147–3197.CrossRefGoogle Scholar
Yentis, SM, Steer, PJ, Plaat, F. Eisenmenger’s syndrome in pregnancy: maternal and fetal mortality in the 1990s. BJOG 1998; 105: 921–922.CrossRefGoogle ScholarPubMed
Yuan-Min, S. Eisenmenger syndrome in pregnancy. Braz J Cardiovasc Surg 2016; 31: 325–329.Google Scholar
Katsurahgi, S, Kamiya, C, Yamanaka, K, et al. Maternal and fetal outcomes in pregnancy complicated with Eisenmenger syndrome. Taiwan J Obstet Gynecol 2019; 58: 183–187.10.1016/j.tjog.2019.01.002CrossRefGoogle ScholarPubMed
Duan, R, Xu, X, Wang, X, et al. Pregnancy outcome in women with Eisenmenger’s syndrome: a case series from west China. BMC Pregnancy Childbirth 2016; 16: 1–8.10.1186/s12884-016-1153-zCrossRefGoogle ScholarPubMed
Wang, H, Zhang, W, Liu, T. Experience of managing pregnant women with Eisenmenger’s syndrome: maternal and fetal outcome in 13 cases. J Obstet Gynaecol Res 2011; 37: 64–70.CrossRefGoogle ScholarPubMed
Subbaiah, M, Kumar, S, Roy, KK, Sharma, JB, Singh, N. Pregnancy outcome in women with pulmonary arterial hypertension: single-center experience from India. Arch Gynecol Obstet 2013; 288: 305–309.CrossRefGoogle ScholarPubMed
Gurumurthy, T, Hegde, R, Mohandas, BS. Anaesthesia for a patient with Eisenmenger’s syndrome undergoing caesarean section. Indian J Anaesth 2012; 56: 291–294.CrossRefGoogle ScholarPubMed