Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2018

Coarctation of the aorta presenting in pregnancy (#76)

Angela Teh 1 , Mark R Morton 1 , Bill Hague 1
  1. Women's and Children's Hospital North Adelaide, North Adelaide, SA, Australia

Objectives: To report a simple but severe coarctation of the aorta presenting antenatally in a primigravida. 

Background: Coarctation of the aorta is a rare cause of hypertension and very rarely presents in pregnancy.  

Case Description: A 20-year-old primigravida presented at 16 weeks gestation with severe hypertension, decrescendo systolic murmur and absent pedal pulses.  She was diagnosed with coarctation of the aorta using magnetic resonance angiography.  Her blood pressure was well controlled antenatally with antihypertensives and she underwent elective Caesarean section under spinal anaesthesia at 37 +4 weeks gestation, giving birth to a healthy boy.  Four hours postpartum the blood pressure became very severe (180-210/90-105mmHg), requiring intravenous therapy and continuous epidural infusion were commenced and maintained for 24 hours in addition to her regular antihypertensives.  Three weeks postpartum her blood pressure was still 150/80mmHg despite use of four oral antihypertensive drug. Her care was transferred to the cardiology team for consideration of endovascular stenting of the coarctation.           

Discussion: Systemic hypertension is well known to be associated with coarctation of the aorta but the literature has not clearly shown worsening of blood pressure control during pregnancy.  There is also no evidence for a predisposition to pre-eclampsia.  In fact, some evidence suggests the blood pressure of women diagnosed with coarctation behaves in a fashion similar to that of normal women throughout pregnancy, including at the time of labour.  The mainstays of treatment during pregnancy are limitation of strenuous physical activity and the control of blood pressure as necessary, ideally with a beta-adrenergic blocker to reduce the shear stress on the arterial wall and hopefully to minimize the small but real risk of aortic dissection.  In labour and the puerperium, the main objective of management is to minimise any additional load on the cardiovascular system.  Vigorous blood pressure control may be necessary postpartum.  Aspirin therapy for pre-eclampsia prophylaxis may not be required. 

Conclusion: Pregnancy may be safe in a patient with simple coarctation without associated cardiac anomaly despite the associated risks of vascular complications such as acute rupture of the aorta and cerebral aneurysm.