An Interesting Case of Medical Termination in a High-risk Pregnancy with Pre-existing Rheumatic Heart Disease Complicated by Arrhythmia and Severe Anemia

Aim and background: To emphasize the critical role of a multidisciplinary approach in managing medical termination of pregnancy (MTP) in high-risk cardiac patients, particularly those with rheumatic heart disease (RHD), coexistent severe anemia, and arrhythmias such as atrial fibrillation (AF).Case description: A 38-year-old G4P2L2A1 woman at 13 weeks and 4 days of gestational age presented with complaints of giddiness and generalized weakness for 2 days.She had a known history of RHD with severe mitral regurgitation (MR) and grade II atrial regurgitation (AR), diagnosed first during her initial pregnancy.The patient reported having taken medical termination pills 24 days prior at a local hospital, which led to the passage of clots the following day without subsequent vaginal bleeding.On evaluation, she was found to be in AF and had severe anemia (Hb < 7 gm/dL).A multidisciplinary team, including obstetricians, cardiologists, and anesthesiologists, managed her condition.She underwent stabilization with blood transfusions and rate control for AF before proceeding with further obstetric care and follow-up.Conclusion: Patients with pre-existing cardiac conditions like RHD face an elevated risk of morbidity during pregnancy termination.Complications such as anemia and arrhythmias further increase this risk and necessitate careful evaluation and coordination between specialties.Clinical significance: This case underscores the critical role of a multidisciplinary strategy in managing MTP in women with significant cardiac disease.Early identification, stabilization, and coordinated intervention are vital to ensuring favorable maternal outcomes in high-risk pregnancies.