A case report recently published in Cureus highlighted that when underlying medical issues are addressed during pregnancy prior to conception, potential complications, including preeclampsia, fetal growth restriction and preterm birth, can be minimized or even averted.
The pregnant patient described in the current case report presented with multiple risk factors, including primary biliary cholangitis (PBC) and chronic hypertension.
The report describes a 42-year-old woman who had a history of adverse obstetric outcomes. She had experienced two previous pregnancies that were complicated with preeclampsia. The first pregnancy resulted in a medical termination at 21 weeks’ gestational age (GA), and the second pregnancy led to fetal demise at 25 weeks’ GA. These pregnancies were conceived via in vitro fertilization with donor gametes.
The patient subsequently underwent evaluations for thrombophilia, hypertension and autoimmune disorders. These analyses led to a likely diagnosis of PBC and chronic hypertension.
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Part of her medical consultation involved a hypertension assessment with the use of ambulatory blood pressure monitoring. The evaluation detected chronic hypertension, and treatment with nifedipine 30 mg daily was initiated. The patient underwent autoimmune disease testing as well, which subsequently led to a probable diagnosis of PBC. Treatment with ursodeoxycholic acid (UDCA) 250 mg twice daily was initiated.
Close monitoring due to severe preeclampsia and PBC
The patient, who was advised to consider the risks associated with another pregnancy, became pregnant once again via frozen embryo transfer with donor gametes. Her medication regimen during her third pregnancy included nifedipine 30 mg daily, UDCA 250 mg twice daily, aspirin 100 mg and enoxaparin 40 mg.
Because of the development of severe preeclampsia, the patient underwent an emergency cesarean section at 33 weeks’, six days’ GA. At that time, she delivered a live male baby who weighed 3.605 lbs.
Preeclampsia, which impacts approximately 10 million pregnancies annually, is associated with an elevated risk for fetal and maternal morbidity and mortality. The treatment for preeclampsia, the study authors stated, is delivery.
The rare autoimmune liver disease PBC is not fully understood. It is thought that among those with the disorder, T lymphocytes cause continuous alterations in bile duct epithelium, resulting in its gradual destruction. These changes in the bile ducts can eventually lead to their disappearance, followed by cirrhosis and liver failure.
The authors concluded, “In this case, although the patient had multiple risk factors, a comprehensive analysis involving close monitoring and tailored medical therapy allowed for a relatively favorable outcome.”
