Hyderabad, Feb 14: In a rare and medically complex case, doctors at CARE Hospitals, Hitech City, successfully managed a high-risk IVF pregnancy complicated by severe rheumatic heart disease, ensuring the safety of both mother and baby—an outcome considered extremely challenging in clinical practice.
Ms. Shalini (name changed), a 47-year-old woman, presented at 31 weeks and 3 days of pregnancy with severe breathlessness and persistent cough unresponsive to routine treatment. The pregnancy was an unbooked IVF conception and was further complicated by a previous Caesarean section, beta-thalassemia trait, and hypothyroidism, placing her at exceptionally high risk.
A 2D echocardiogram revealed Chronic Rheumatic Heart Disease (CRHD) with severe mitral stenosis, mild involvement of other heart valves, and pulmonary arterial hypertension. As per WHO classification, such cases fall under Class IV, where pregnancy carries an extremely high risk of maternal complications and is generally considered contraindicated.
Multidisciplinary Critical Care Approach
The patient was immediately shifted to critical care and stabilized with intensive medical management, including diuretics, heart-rate-controlling medication, and blood transfusions. A dedicated multidisciplinary team comprising cardiologists, obstetricians, anaesthesiologists, intensivists, pulmonologists, and neonatologists worked in close coordination to balance maternal safety while prolonging the pregnancy to improve fetal outcomes.
Despite the severity of her condition, the pregnancy was carefully continued from 31 weeks to nearly 35 weeks under strict monitoring. Steroids were administered to enhance fetal lung maturity, and fetal heart rate was continuously monitored.
After meticulous planning and informed consent, an elective Lower Segment Caesarean Section (LSCS) was performed at 34 weeks and 4 days under combined spinal and epidural anesthesia to minimize cardiac stress. The surgery was uneventful.
The baby, though preterm, was stable at birth, cried immediately, and was observed in the NICU for 4–5 days before being discharged in good health. The mother remained hemodynamically stable throughout the peri-operative period and was monitored in the SICU and ICCU before being shifted to the ward. She has now recovered well and is being discharged with detailed follow-up advice.
Expert Commentary
Dr. Abhinaya Alluri, Senior Consultant – Obstetrician, Gynaecologist, Laparoscopic Surgeon & Infertility Specialist, CARE Hospitals, Hitech City, said:
“Pregnancy in women with severe rheumatic heart disease is one of the most challenging situations in obstetrics. This was a rare and extremely high-risk case, especially given the patient’s age and IVF conception. Early suspicion, timely cardiac evaluation, and coordinated multidisciplinary care helped us achieve a safe outcome for both mother and baby. Breathlessness during pregnancy should never be ignored, as heart disease often goes undiagnosed.”
Dr. Ashutosh Kumar, Clinical Director – Cardiology & Electrophysiology (EP), added:
“Late pregnancies are increasingly common and often associated with conditions like hypertension and diabetes. This case was complex as the patient had chronic rheumatic heart disease with severe mitral valve disease and thalassemia, significantly increasing the risk of heart failure and pulmonary edema. She came to us in a critical condition, but with timely intervention and strong teamwork, we were able to stabilise her and ensure a safe delivery, with both mother and baby doing well.”
The case was successfully managed with the support of a highly experienced team including specialists from Internal Medicine, Pulmonology, Anaesthesiology, Paediatrics, Cardiology, Obstetrics, Critical Care, and Neonatology, ensuring optimal maternal and neonatal outcomes.
A Growing Need for Specialised Cardiac-Obstetric Care
This case underscores the importance of early detection, specialised cardiac-obstetric care, and multidisciplinary collaboration—particularly as India witnesses a rise in advanced maternal age and IVF pregnancies.
