Narentharen Selvarajah
Fellowship of the Royal Australian College of General Practitioners, Malaysia
Title: Case of a High Risk Pregnancy: A holistic management approach of Ventricular Septal Defect at Rural Primary Care
Biography
Biography: Narentharen Selvarajah
Abstract
Maternal congenital cardiac abnormalities increases maternal morbidity and mortality.
We present a 36-year-old gravida III para II with ventricular septal defect diagnosed at 11 years of age. No surgical repair was done due to her poor socioeconomic background and she defaulted follow up. She presented at 14 weeks period-of-amenorrhea(POA) with breathlessness and pedal oedema. Vital signs were normal with a grade 3 pan-systolic murmur.
She had microscopic hypochromic anaemia with a haemoglobin of 8.3 grams per desiliter. Echocardiography showed a peri-membranous outlet ventricular-septal-defect measuring 0.5cm with a left to right shunt and moderate tricuspid regurgitation with moderate pulmonary hypertension.
Patient was managed by a multidisciplinary team. Her health seeking behaviour improved after constant aggressive counselling. She had no significant failure issues, blood pressure remained within normal limits and foetal growth parameters matched gestation age throughout the pregnancy. With optimization, haemoglobin remained stable above 12. Serial echocardiography did not show progression of disease. No abnormalities on detailed foetal ultrasound at 22 weeks of POA. Social services contributed financial aid and home care nursing team ensured compliance to treatment.
Patient was transferred to a tertiary cardiac centre for induction-of-labour at 37 weeks POA. She delivered a healthy baby boy(Apgar score 9,10) with a birth weight of 2.4kg via spontaneous-vaginal-delivery at 37 weeks and 2 days POA. She was discharged home well three days later.
Skillful pre-conception counseling and holistic management throughout pregnancy by a multidisplinary team becomes an essential component of the care of pregnant women with cardiac disease.