Management of Severe Mitral Stenosis and Intrahepatic Cholestasis in a Pregnant Woman: A Case Report on Achieving Favorable Maternal and Neonatal Outcomes

A BSTRACT Mitral stenosis (MS) and intrahepatic cholestasis of pregnancy (IHCP) are two distinct and complex conditions that can significantly complicate pregnancy, leading to increased maternal and fetal morbidity and mortality. While MS primarily affects cardiac function due to obstructed blood flow from the left atrium to the left ventricle, IHCP impacts hepatic function and poses risks to fetal well-being. This case report describes the multidisciplinary management of a 26-year-old pregnant woman at 29 weeks gestation, presenting with severe MS and IHCP. The patient had a history of previous full-term normal vaginal delivery (uneventful) and a medical termination of pregnancy due to fetal anomalies. Her current pregnancy was complicated by severe MS, diagnosed via routine 2D echocardiography, revealing severe tricuspid regurgitation, severe pulmonary arterial hypertension, and dilated atria and ventricles, with preserved left ventricular function. Additionally, she presented with pruritus and deranged liver function tests indicative of IHCP. The management strategy included medical therapy with beta-blockers, diuretics, anticoagulants, and ursodeoxycholic acid (UDCA) for IHCP, along with strict bed rest and fluid restriction. The patient was closely monitored throughout her pregnancy by a multidisciplinary team comprising obstetricians, cardiologists, and anesthetists. At 36.4 weeks, she went into spontaneous labor and delivered a healthy male infant weighing 2.3 kg via vaginal delivery, with favorable APGAR scores. Immediately postpartum, the patient was stable, and the postpartum period was uneventful and got discharged with instructions for continued cardiac follow-up. This case underscores the importance of a coordinated multidisciplinary approach in managing high-risk pregnancies complicated by severe MS and IHCP. The successful outcome, including the delivery of a healthy neonate and the stabilization of maternal health, highlights the efficacy of early diagnosis, appropriate medical management, and vigilant monitoring. The insights from this case contribute to the existing literature on the management of complex cardiovascular and hepatic conditions during pregnancy, offering valuable guidance for similar high-risk scenarios.