Dataset Information

Challenging management of a pregnancy complicated by Eisenmenger syndrome; A case report.

ABSTRACT:

Introduction and importance

Women with Eisenmenger syndrome are usually advised to avoid pregnancy because of the high maternal mortality rate of 30-50% which increases up to 65% in the case of a cesarean section. Successful management of Eisenmenger syndrome in pregnancy is tricky and has a narrow margin of safety; however, carefully coordinated multidisciplinary care can profoundly optimize the chances of survival for both mother and baby.

Case presentation

A 28-year-old, 24-week-pregnant patient with a non-corrective ventricular septal defect (VSD) was diagnosed with Eisenmenger syndrome but elected to continue her pregnancy despite the high risks on her and her fetus. Therefore, a multidisciplinary team was assembled to fully monitor the patient and ensure that she reaches 32 weeks before delivery.

Clinical discussion

Multiple scenarios for timing and mode of delivery were discussed. Following the recommendation of the 2018 European Society of Cardiology guidelines and because of the fetus' transverse position, a cesarean section was performed at week 32 and both the patient and her child were saved.

Conclusion

Termination of pregnancy is the safer option only if it were done early on in the pregnancy. Thus, when the pregnancy is continued, an expert multidisciplinary team is put together to support the patient.

SUBMITTER: Slaibi A

PROVIDER: S-EPMC8379476 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:RationaleAcquired neuromyotonia syndrome is a rare form of peripheral nerve hyperexcitability syndrome. It is characterized by spontaneous and continuous muscle contractions. Acquired neuromyotonia syndrome is mainly observed in patients with autoimmune diseases or tumors, but it is a rare neurological clinical manifestation in patients with mercury poisoning.Patient concernsA 56-year-old woman presented with continuous and involuntary muscle twitching in her legs for 2 months; it was accompanied by a burning sensation in the lower limbs, insomnia, fatigue, and night sweats. These symptoms did not disappear during sleep.DiagnosesToxicological blood analysis via atomic fluorescence spectrometry revealed that the level of mercury was 0.07 μmol/L (normal level: <0.05 μmol/L). Her urinary mercury level measured using the cold atomic absorption method was 217.50 μmol/mol creatinine, which was considerably higher than the reference range (0-2.25 μmol/mol creatinine for people not in contact with mercury, 0-20 μmol/mol creatinine following long-term exposure). Upon further testing, a high level of mercury (10,572 mg/kg) was detected in the patient's cream. Accordingly, this patient was diagnosed with mercury poisoning.InterventionsTreatment with 2,3-dimercapto-1-propanesulfonic acid (DMPS) was initiated. Her urinary mercury level decreased to 9.67 μmol/mol creatinine, and her neuromyotonia syndrome and hyponatremia were relieved, with urine protein completely disappearing after 3 months of treatment.OutcomesAfter DMPS treatment, the clinical manifestations of the nervous system disappeared and electrolyte parameters returned to normal levels.LessonsAcquired neuromyotonia syndrome is a rare disorder caused by the hyperexcitability of peripheral nerves, resulting in spontaneous and continuous muscle contraction. Mercury poisoning should be considered in patients with neuromyotonia syndrome. Early detection of mercury poisoning can prevent unnecessary examinations and treatments.