Abstract Eisenmenger’s syndrome in pregnancy is associated with a high maternal and fetal morbidity and mortality. When it occurs with severe preeclampsia, the morbidity and mortality are higher. We report the case of a 30 weeks’ pregnant woman with Eisenmenger’s syn- drome and severe preeclampsia. Cesarean section was performed due to severe preeclampsia and an unfavor- able cervix under general anesthesia. The intraoperative period was uneventful and a healthy 1300 g male infant was delivered, but the patient died on the second postoperative day due to a pulmonary embolism. This case confirms the frequently fatal maternal outcome of Eisenmenger’s syndrome in pregnancy. Early termina- tion of pregnancy is the treatment of choice. Keywords Eisenmenger’s syndrome · Pregnancy · Severe preeclampsia · Cesarean section Introduction Eisenmenger’s syndrome was first described in 1897 [1]. In 1958, Wood defined Eisenmenger’s syndrome as an elevated pulmonary artery pressure and pulmonary vas- cular resistance, resulting in a reversed or bidirectional shunt at any site between the two circulation systems [2]. It can occur with several congenital heart defects, i.e. ventricular septal defect (VSD), atrial septal defect (ASD) and patent ductus arteriosus (PDA) [3]. VSD is the most frequent underlying shunt defect. The incidence of Eisenmenger’s syndrome is approximately 3% of patients with congenital heart defects [4]. Maternal mor- tality in this situation is still high and maternal mortality in association with VSD is higher (60%) than in associa- tion with ASD and PDA [5]. Severe preeclampsia is one type of hypertension in pregnancy and associated with high maternal and perina- tal morbidity and mortality [6, 7]. There is no survival case of Eisenmenger’s syndrome complicated by severe preeclampsia reported in the literature [8]. Pulmonary embolism is one of the common complica- tions in Eisenmenger’s syndrome with the incidence of 13.2% [9]. When this complication occurs in pregnant women with Eisenmenger’s syndrome, the mortality is high [5]. Herein, we report the fatal outcome of a preg- nant woman with Eisenmenger’s syndrome associated with VSD who underwent cesarean section because of severe preeclampsia and an unfavorable cervix. She died from pulmonary embolism in the postpartum period. Case report A 21-year-old Thai woman, primigravida, 30 weeks’ gestation, came to the emergency room of King Chulalongkorn Memorial Hospital, Bangkok, Thailand, because of progressive dyspnea. She had been diagnosed as VSD with Eisenmenger’s syndrome based on cardiac catheterization 8 years previously, and was awaiting heart lung transplantation. She had been lost to follow up until this admission. She had not received antenatal care until 3 weeks before this admission, when she developed progressive dyspnea, and was managed at a private hospital. There was no sign of pulmonary em- bolism, such as dyspnea, tachypnea, cough, hemoptysis, pleuritic chest pain with splinting, and friction rub, at that time [10]. The doctor referred her to the tertiary-care hospital but she refused and went back home. Her past medical history was otherwise normal. On physical assessment the pulse rate was 96/min, respiratory rate 24/min and blood pressure 170/110 mmHg. There was marked cyanosis and clubbing of fingers. A right ventricular heave was noted, and there was a fixed split second heart sound with an increased pulmonic component. There was grade II/VI systolic murmur at the left parasternal border. Breath sounds were normal. The size of the uterus was consistent with 30 weeks’ ges- tation, with a fetal heart rate of 152/min. Both legs showed pitting edema and hyperreflexia of the deep tendon reflexes. V. Phupong ( ✉ ) · C. Charakorn · K. Prammanee Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand e-mail: vorapong.p@chula.ac.th Tel.: +66-2-2564241, Fax:+66-2-2549292 P. Ultchaswadi · S. Prasertsri · S. Charuluxananan Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, Thailand Arch Gynecol Obstet (2003) 267:163–166 © Springer-Verlag 2003 CASE REPORT Vorapong Phupong · Pornthip Ultchaswadi Chuenkamon Charakorn · Kongkwan Prammanee Suthisinee Prasertsri · Somrat Charuluxananan Fatal maternal outcome of a parturient with Eisenmenger’s syndrome and severe preeclampsia Received: 5 October 2001 / Accepted: 3 December 2001