{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T16:59:11Z","timestamp":1754153951822,"version":"3.41.2"},"reference-count":21,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,24]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>The study presents a second gravida in her middle age at 25\u2009weeks and 2-day period of gestation with progressive dyspnoea even at rest (New York Heart Association Class IV), palpitations of 3\u2009months, tachycardia, tachypnoea, pallor, clubbing, elevated jugular venous pressure and SpO2 of 80\u201390%. ECG revealed sinus tachycardia, right ventricular strain and right bundle-branch block. Echocardiography highlighted increased right pulmonary arterial pressures (pulmonary artery pressure of 60\/30\/42\u2009mm Hg, pulmonary capillary wedge pressure of 30\u2009mm Hg), a dilated right ventricle and elevated right ventricular systolic pressure. A chest X-ray identified bronchiectasis changes. Despite maintaining oxygen saturation through a high-flow nasal cannula (FiO2, 30%), the patient experienced persistent tachypnoea and required oxygen (FiO2, 70%). The ongoing cardiac and pulmonary evaluation did not reveal any autoimmune, hormonal or infective causes of bronchiectasis or pulmonary hypertension.<\/jats:p>\n<jats:p>Given the worsening condition, a caesarean section was performed at 32 weeks gestation in a semirecumbent position under epidural anaesthesia with transversus abdominis plane block and she delivered a live preterm neonate. The postoperative phase was managed with inotropes and high-flow nasal oxygen with gradual weaning off of oxygen over 12 weeks.<\/jats:p>\n<jats:p>The patient\u2019s complex presentation highlights the importance of management of a high-risk case of pulmonary hypertension while continuing a pregnancy with integrated care by addressing severe cardiovascular and pulmonary issues.<\/jats:p>","DOI":"10.1136\/bcr-2024-264211","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T10:19:51Z","timestamp":1751969991000},"page":"e264211","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic quagmires to miraculous resolutions: pulmonary hypertension in pregnancy"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0276-0102","authenticated-orcid":false,"given":"Indrani","family":"Mukhopadhyay","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, Armed Forces Medical College, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjay","family":"Singh","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Armed Forces Medical College, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Namrata","family":"Das","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Armed Forces Medical College, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akanksha","family":"Tevatia","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Armed Forces Medical College, Pune, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,5]]},"reference":[{"key":"2025072218350903000_18.7.e264211.1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2147\/IBPC.S242242","article-title":"Pulmonary Hypertension in Pregnancy: Challenges and Solutions","volume":"15","author":"Afify","year":"2022","journal-title":"Integr Blood Press Control"},{"key":"2025072218350903000_18.7.e264211.2","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0079-2016"},{"key":"2025072218350903000_18.7.e264211.3","doi-asserted-by":"crossref","unstructured":"Low T-T , Guron N , Ducas R , et al . 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