Revista Chilena de Obstetricia y Ginecología (Jan 2002)
SINDROME DE EINSENMENGER Y EMBARAZO
Abstract
Se presenta un caso clínico de una paciente de 21 años, M1, portadora de un Síndrome de Einsenmenger diagnosticado posterior a su primer parto, que ingresa a la Unidad de Alto Riesgo Obstétrico del Hospital San Juan de Dios cursando un Embarazo de 14 sem, en capacidad funcional III, oxígeno -dependiente, la paciente se maneja con tratamiento médico hasta lograr viabilidad fetal, a las 28 sem se decide interrupción del embarazo dado el compromiso materno progresivo, con riesgo vital y deterioro fetal. Se realiza cesárea electiva por un equipo multidisciplinario y multicéntrico, obteniéndose un RN vivo en buenas condiciones, sin incidentes anestésicos ni quirúrgicos durante el procedimiento. La paciente evoluciona en el puerperio inmediato con inestabilidad hemodinámica y shock cardiogénico, falleciendo a las 39 horas de puerperio. Se analiza el tema del Síndrome de Einsenmenger, su manejo actual, mal pronóstico, y la contraindicación de embarazo dado su alta mortalidad materna y compromiso fetalWe present a clinical case of a 21 year old patient, in her second pregnancy (multiparous 1), with the diagnose of Einsenmenger's Syndrome. The diagnosis was made after her first delivery. She was admitted at the High Risk Obstetric Unit during her 14 week of the second pregnancy. On admission she had Functional Capacity (FC) III and oxygen-dependent. She was managed medically up to 28 weeks; due to the progressive maternal compromise with vital risks and fetal damage, a preterm cesarean section was perfomed by a multicentric and multidisciplinary team. The result was a newborn alive, and during the intervention there weren't anesthetical or surgical incidents. The patient was, since the delivery, with hemodinamic instability and cardiogenic shock. She died 39 hours after the delivery, despite all medical efforts. We review the Einsenmenger's syndrome, the actual management, bad prognosis and the need of preventing pregnancy in these patients due to the high maternal mortality risk and fetal compromise
