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11: Congenital: Case 2 Part 3: Pregnant Kirsten

Kirsten discovers she is pregnant

Kirsten fails to attend her follow up appointments. Two years later she phones the nurse specialist and informs her that she is pregnant. The pregnancy was not planned and she has not had any recent echo or MRI scans since her surgery. The nurse specialist arranges an appointment for Kirsten at a joint cardiac and obstetric clinic. This is run by a consultant cardiologist in CHD, a consultant obstetrician and a cardiac CHD nurse specialist. They review Kirsten with a repeat echo at 14 weeks gestation. Kirsten's pulmonary valve and right ventricle are working well. She has experienced some palpitations that last for a few minutes but she does not get dizzy, or experience breathlessness or chest pain. The nurse specialist arranges a 24hr tape for Kirsten and makes arrangements for her to be followed up both by her local team and at least once more in the clinic with a repeat echo scan. Kirsten's case is discussed at a cardiac obstetric multidisciplinary team meeting and a care plan is developed.

Cardiac Obstetric Care Plan: Kirsten Campbell: 1234567890: 32weeks
Diagnosis
  • Tetralogy of Fallot
  • Moderate right ventricular dilation
Prev intervention
  • Repair to Tetralogy of Fallot 1987
  • Pulmonary Valve Replacement 2013
Current meds
  • Folic acid
Obs history
  • 1st pregnancy
Examination (15/01/15)
  • 60bpm & regular BP 123/64mmHg
  • No significant heave or thrill
  • HS I and II ESM in pulmonary region
  • Chest clear, no peripheral oedema
Investigations
  • ECHO (12/01/15)
    • Moderately dilated RV with preserved function
    • Normal LV dimensions
    • RVSP 25mmHG RAP
    • Peak velocity across PV 2.8m/s
  • ECG (2013)
    • Sinus rhythm
    • RBBB
    • QRS 146ms
  • CPET (2013)
    • Maximal test
    • Good BP and HR response without desaturation
    • Normal spirometry
    • VE/VCO2 slope 26
    • Peak VO2 80% predicted
  • CMRI (Oct 2014)
    • Moderately dilated RV
    • Good RV dysfunction
    • Good LV function and normal size
    Delivery Plan

    Location: Local General Hospital

    • Aim for spontaneous labour, vaginal delivery
    • Early epidural
    • Priority to optimise analgesia
    • Invasive monitoring not indicated
    • No restrictions to length of second stage

    If concerns from cardiology perspective contact on-call Cardiologist at SGH.

    Post Partum Care
    • No routine requirement for obstetric HDU
    Follow Up
    • GJNH

    Kirsten's pregnancy


    Module name: Inherited and Congenital Cardiac Disease

    Map name: 11: Congenital: Case 2 Part 3: Pregnant Kirsten

    Map ID: 1818

    Node ID: 47981