Management of a pregnant woman with fibromuscular dysplasia

Abstract

We discussed the case of a young hypertensive woman. The diagnosis of multifocal FMD of the right renal artery was first suspected during her third pregnancy. A worsening of hypertension during pregnancy combined with poor drug adherence made blood pressure control difficult. A cesarean section was performed at 31 weeks gestation, considering the association of suboptimal control of blood pressure and proteinuria, despite the fact that the latter was present from the beginning, and probably reflected the severity of hypertension rather than superimposed preeclampsia. After delivery, renal artery angioplasty led to an almost complete normalization of blood pressure. Vascular screening did not disclose other arterial lesions, with the exception of hepatic artery stenosis. FMD is less rare than previously thought. In young patients with recently diagnosed hypertension, renal artery angioplasty often cures hypertension or at least substantially improves blood pressure. The risk of pregnancy in patients with FMD may be higher than that in healthy normotensive or even hypertensive women, both for the mother and the child. Therefore, all hypertensive women of child-bearing age should be screened for renal artery FMD using state-of-the-art imaging methods, such as CT angiography or, if contraindicated, magnetic resonance angiography.