Maria is a 28-year-old woman in the 26th week of her third pregnancy. She is obese, a heavy smoker, has used weight loss pills on several occasions, and suffers from type 2 diabetes mellitus. Her previous two pregnancies were complicated.
Maria presents with complaints of progressive exertional dyspnea and fatigue of several weeks duration. She also reported several recent syncopal episodes. After a variety of tests, she was admitted to labor and delivery at St. Michael's Medical Center and was prescribed bed rest, oxygen, diuretics, and heparin. Despite this therapy, Maria continued to report progressive dyspnea. At 32-weeks' gestation, the placement of a pulmonary artery catheter demonstrated moderate primary pulmonary hypertension presenting a significant risk to the mother. Maria was treated accordingly. At 36-weeks' gestation, the patient suffered premature rupture of membranes followed by active labor. The progression of labor was insufficient and a cesarean section was performed resulting in the delivery of a healthy male infant. At the recommendation of her OB-GYN, in order to avoid a future life-threatening pregnancy, a bilateral tubal ligation was performed with the patient's consent. Post-delivery, the patient was treated in the intensive care unit for five days for her primary pulmonary hypertension. She was discharged 20 days later.