Dr Emi Kondo1,2, Dr Kohshi Setoyama3, Dr Satoshi Kubo4, Dr Kazuaki Iio2, Dr Honami Bell Tatta3, Dr Yuka Isoshima2, Dr Ryosuke Tajiri2, Dr Shoko Amimoto2, Prof. Masaharu Kataoka3, Prof. Kiyoshi Yoshino2
1Department of Obstetrics and Gynecology, National Hospital Organization Kokura Medical Center, Kitakyusyu-City/Kokuraminamiku/Harugaoka, Japan, 2Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyusyu-City/yahatanishiku/iseigaoka, Japan, 3The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyusyu-City/yahatanishiku/iseigaoka, Japan, 4The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyusyu-City/yahatanishiku/iseigaoka, Japan
Biography:
I graduated from University of Occupational and Environmental Health, Japan in 2005, assumed as Chief of Obstetrics there from 2020 to 2023, and am presently a clinician specializing in obstetrics and gynecology at National Hospital Organization Kokura Medical Center.
Abstract:
Introduction: Systemic lupus erythematosus (SLE)-associated myocarditis is often asymptomatic during non-pregnant periods. However, symptoms may emerge during pregnancy, mimicking dilated cardiomyopathy.
Case: A 33-year-old primigravida was diagnosed with SLE at age 21. Pre-pregnancy SLE Disease Activity Index score was four. She was treated with oral prednisolone (10 mg), hydroxychloroquine (200/400 mg), and weekly belimumab (200 mg). An echocardiogram showed the ejection fraction of the left ventricle (LVEF) to be 45%. Following conception via frozen-thawed embryo transfer, her LVEF ranged between 40-45% at 13 and 25 weeks. At 313/7 weeks, she experienced left chest discomfort with an LVEF of approximately 40%, indicating a potential exacerbation of SLE-related myocarditis. LVEF ranged between 35-40% up to delivery, with an NT-proBNP level of 108 pg/ml the day before delivery. At 371/7 weeks, cesarean section was performed, and an inverted uterus with placenta accreta was observed. The placenta was removed, during which the uterus was repositioned, however, bilateral uterine artery embolization and subsequent supravaginal hysterectomy, along with blood transfusion totaling 5,820 mL, were necessary to achieve postoperative hemostasis. During and after the procedures, intensive monitoring including central venous pressure (CVP) and mean pulmonary artery pressure (mPAP) was performed. The CVP and mPAP on postoperative day 1 tended to be elevated, and furosemide and cardioprotective agents were aggressively administered. She was discharged on day 8.
Conclusion: A detailed assessment of maternal circulation and prompt therapeutic intervention through a multidisciplinary approach enabled safe delivery management without exacerbation of heart failure symptoms in the perioperative period.
Keywords
SLE, myocarditis, placenta accreta