Pediatric Cardiology: A Case Study

Hannah is a 26yo, G4 P1021, who is currently 35 weeks 1-day based on an EDD of 02/11/18. She has had somewhat spotty PNC. She has been in and out of jail during this pregnancy. She was incarcerated from September from November and at that point was told that there was something going with the baby’s heart. She made an appointment with Pediatric Cardiology at ETSU but was arrested again for violation of parole shortly before this visit and has not had any further evaluations. She was also diagnosed HTN during this pregnancy on her intake into jail. She has not history of chronic HTN and is currently not on any medication. Her BP today is 118/80. She does have a trace of protein but denies any symptoms of preeclampsia. She found out she

Fetal biometry is fairly symmetric and consistent with dates. A detailed anatomic survey was overall notable for a congenital heart defect. The 4-chamber view appeared normal. The LVOT appeared normal. Abnormalities were first noted in the RVOT where it appeared to be somewhat enlarged with a prominent pulmonary valve. The three-vessel view appeared abnormal. In arch views the aortic arch appeared slightly narrow. There were only 2 vessels arising from the head and neck area. There was a slightly increased velocity as well. In the 4-chamber view there is an enlarged vessel behind the left atrium suspicious for descending aorta. Also, the SVC looked slightly increased as well. There were no other gross abnormalities noted within the fetus outside of the outflow cardiac abnormalities. Amniotic fluid was within normal limits. Doppler examination was normal and BPP was 8/8. Peak systolic velocity was .8

Most of it focused on the cardiac defect. We did spend some time talking about her gestational HTN and how it was diagnosed. She does report that this could have been somewhat of a withdrawal when she entered into the jail system. For now, as long as her BPs remain normal and she has no proteinuria we are overall reassured but given the fact that she has been labeled with HTN I would think that we need to continue with antenatal testing. We also discussed her hepatitis C and the potential risk to the fetus. She reports that her LFTs have been elevated and I would reevaluate them in the third trimester or after delivery. If they are elevated and she does have chronic active hepatitis C she will need to seek treatment soon after delivery and she is aware of this. We also discussed the potential for an anti-E antibody. I do not have a titer but certainly if she has reached a critical level we would follow MCA Dopplers and the MCA Doppler was within normal limits. Furthermore, there was no evidence of a hydropic fetus today. I explained that antibodies can lead to fetal anemia and we will reevaluate this at her testing after we get her antibody titer. We did review Subutex. She was on the same dose with her last baby who did not have any evidence of withdrawal. We did talk about NAS and she is aware of this potential