title: Postnatal diagnosis of maternal congenital heart disease: missed opportunities.
abstract: A 30-year-old primigravida with no known comorbidities presented to the emergency department at 29+6/40 gestation, with breathlessness. The initial diagnosis was pulmonary embolism, which was later revised following initial investigations and considered to be pre-eclampsia/HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. Following caesarean section and delivery of a live baby, the patient had episodes of cyanotic hypoxia and was admitted to intensive care. A provisional diagnosis of idiopathic pulmonary hypertension was performed. Decompensation led to transfer to a specialist intensive care unit for extracorporeal membrane oxygenation, where a diagnosis of patent ductus arteriosus and Eisenmenger's syndrome was made. Heart disease is the leading indirect cause of maternal death, and Eisenmenger's syndrome in pregnancy carries a 50-65% mortality. A literature review demonstrated that this is the only reported case of a postnatal diagnosis of Eisenmenger's syndrome. We considered missed opportunities to make an earlier diagnosis, so that patients and doctors will benefit from the lessons we learnt.
authors.affiliation: Royal Preston Hospital, Preston, Lancashire, UK.
authors.forename: Ananya
authors.initials: A
authors.lastname: Vashisht
authors.affiliation: Royal Bolton Hospital, Bolton, UK.
authors.forename: Narmada
authors.initials: N
authors.lastname: Katakam
authors.affiliation: Royal Bolton Hospital, Bolton, UK.
authors.forename: Samina
authors.initials: S
authors.lastname: Kausar
authors.affiliation: Royal Bolton Hospital, Bolton, UK.
authors.forename: Neena
authors.initials: N
authors.lastname: Patel
authors.affiliation: Royal Bolton Hospital, Bolton, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Stratton
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000175:diagnosis*; D004417:Dyspnea / Q000150:complications / Q000209:etiology; D004541:Eisenmenger Complex / Q000150:complications / Q000175:diagnosis*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D011225:Pre-Eclampsia; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis*; D011256:Pregnancy Outcome; D016896:Treatment Outcome