Three pregnancies in a Marfan syndrome patient after a mitral and tricuspid valve surgery
Department of Gynecology, Obstetrics and Gynecological Oncology, Bytom, Medical University of Silesia, Katowice, Poland.Ginekologia polska (Impact Factor: 0.6). 04/2013; 84(4):314-7. DOI: 10.17772/gp/1583
Marfan syndrome is an autosomal dominant disorder of connective tissue with up to 25% of cases related to a spontaneous mutation. It has been associated with perinatal loss, preterm labor and, potentially a rupture of the maternal aortic arch. We present a case of a woman diagnosed with Marfan syndrome after a miscarriage of her first pregnancy. At the time of diagnosis she had mild aortic bulb dilation and insufficiency of the mitral and tricuspid valves. She underwent cardiosurgical correction, after which she had two uneventful pregnancies. This case suggests that preconceptional correction of valve defects in women with Marfan syndrome may decrease the risk of cardiac decompensation during future pregnancies. Additionally close clinical follow up and the appropriate use of beta-adrenergic blockade may decrease the risk of aortic rupture, a significant risk factor for mortality in pregnant women.
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ABSTRACT: We present a case report of pregnant woman with Takayasu's arteritis diagnosed in childhood. The treatment was modified owing to the fact that the patient wished to get pregnant and she conceived spontaneously within the first year after that. Vasculitis activity was low during pregnancy Hypertension was treated with methyldopa and metoprolol. After the confirmation of pregnancy daily administration of prednizone and enoxaparin (at a dose of 5 mg and 40 mg, respectively) has been started. In the third trimester of pregnancy the values of blood pressure increased. The patient required higher doses of antihypertensive drugs. Proteinuria appeared in the daily urine collection. The values of liver enzymes have increased. Elective cesarean section was performed at 37 weeks of gestation due to narrow oscillations revealed by CTG and weaker fetal movements reported by the mother A male infant (weight 2840 g, Apgar 10) was born. The mother and the child were discharged on day 5 of the postpartum. Treatment with steroids, antihypertensive drugs, thyroxine and enoxaparin was continued. Hypertension and preeclampsia are the most dangerous complications in pregnant women with Takayasu's disease. They can affect the health status of the mother and the child. Maternal blood pressure should be controlled very accurately on the two superior limbs. Vaginal delivery of the baby is preferred. Cesarean section is indicated when the values of the maternal blood pressure are elevated in the second part of vaginal deliveryGinekologia polska 02/2014; 85(1):62-5. · 0.60 Impact Factor
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