PF.76 Pregnancy Outcome and Management of Fetal Hypertrophic Cardiomyopathy: A Case Report and Literature Review

Abstract

Background We report an interesting case of a diabetic pregnancy associated with fetal hypertrophic cardiomyopathy. The diagnosis was made following an emergency caesarean delivery at 37 weeks for fetal distress and was associated with severe metabolic acidosis and poor Apgar scores. The baby was transferred to Liverpool Women's Hospital tertiary unit and required ventilation support. Case Our case describes a 24-year-old, Para 1 with a previous emergency caesarean section for fetal distress. She has a background of Type 2 Diabetes since 2008 for which she is taking 500 mg Metformin BD. She is a chronic smoker with a raised BMI of 34. The patient's anomaly scan was normal and a fetal echocardiography did not show any signs of congenital, valvular, or structural abnormality. Her 30 week growth scan was normal and at 36 + 6 weeks she was referred to triage for decreased fetal movements. A subsequent ultrasound scan showed growth above the 90th centile with polyhydramnios and no evidence of hydrops. She had a suboptimal CTG and a category 2 emergency caesarean section was performed. Postnatal echocardiography confirmed the diagnosis of hypertrophic cardiomyopathy, which resolved after several weeks. Conclusion There is an increased risk of hypertrophic cardiomyopathy among newborns of diabetic mothers and around 1 in 5000 people are affected in the UK. This condition is normally asymptomatic in utero and may only result in congestive heart failure in the immediate postnatal period. Neonatal hypertrophic cardiomyopathy usually has a poor prognosis that is not secondary to a cardiac malformation with the exception of transient hypertrophic cardiomyopathy in neonates of diabetic mothers. Our case indicates that diabetic hypertrophic cardiomyopathy can present with acute fetal distress even in the absence of hydrops and suggest this condition may cause stillbirth in women with type 2 diabetes, despite being more prevalent in type 1 diabetics. There is little literature regarding this condition and we aim to heighten awareness and surveillance of neonates after acute fetal distress. Further research is recommended looking at the role of routine prenatal echocardiography for pre natal diagnosis of cardiomyopathy and antenatal management.