Pregnancy in the setting of Eisenmenger physiology is associated with very high maternal and fetal risk. Complex congenital cardiac anatomy and resource limitations for advanced imaging or targeted pulmonary hypertension therapies further complicate diagnosis and peripartum management. Published data specifically addressing pregnancy with uncorrected double-outlet right ventricle (DORV) and Eisenmenger physiology are sparse, leaving clinicians without robust evidence to guide management in these high-risk situations.
A 25-year-old primigravida at 34 weeks' gestation presented with progressive dyspnoea and generalized oedema. On initial assessment she had a heart rate of 130 beats per minute, respiratory rate of 25 breaths per minute, and an oxygen saturation of 80% despite face-mask oxygen. Cardiac auscultation revealed a loud second heart sound and a systolic murmur. These clinical features prompted urgent echocardiographic assessment and multidisciplinary consultation involving cardiology and obstetrics.
Transthoracic echocardiography documented large ventricular and atrial septal defects with colour Doppler flow, severe tricuspid regurgitation, and an estimated systolic pulmonary artery pressure of 85 mmHg. In the context of marked hypoxaemia, these findings supported a diagnosis of probable Eisenmenger physiology. The direction of intracardiac shunting and measurements of pulmonary vascular resistance were not reported.
The aorta appeared to arise predominantly from the right ventricle on echocardiography, findings supportive of a suspected DORV. However, detailed anatomic characterization — including the exact origin of both great arteries, the relationship between the ventricular septal defect and the great arteries, and the DORV subtype — could not be defined with the available imaging.
After combined cardiology and obstetric assessment, labour was induced. Vaginal delivery occurred four hours after induction. The decision-making process, including specific anaesthetic approach or use of pulmonary vasodilator therapies, was not reported in the source.
Immediately postpartum the patient required close monitoring. Her haemoglobin level fell to 7 g/dL and she received two units of packed red blood cells. She was observed in intensive care for three days, then transferred to the cardiology service on hospital day 6. The patient was discharged in stable condition on day 7. The report documents maternal survival through the peripartum period and the first postpartum week.
The liveborn neonate weighed 2.7 kg and had an initial Apgar score of 5. The infant was admitted to the neonatal intensive care unit for stabilization and monitoring. Further neonatal details, including subsequent neonatal course, interventions, or follow-up, were not provided in the report.
This case demonstrates survival of both mother and neonate through delivery and the early postpartum period despite late recognition of probable Eisenmenger physiology and suspected complex congenital heart disease consistent with DORV. Key echocardiographic features supporting the diagnosis included large septal defects, severe tricuspid regurgitation, and markedly elevated estimated systolic pulmonary artery pressure.
However, the report has important limitations that restrict interpretation and generalizability. Haemodynamic parameters central to confirming Eisenmenger physiology — specifically shunt direction under baseline conditions and pulmonary vascular resistance measurements — were not documented. The congenital cardiac anatomy could not be fully delineated: the precise origins of the great arteries, the VSD–great-artery relationship, and the DORV subtype remain undefined. Details of anaesthetic management, intrapartum haemodynamic monitoring, use of pulmonary vasodilator therapy, and more granular neonatal data were not reported. Because this is a single case in a resource-limited setting, it does not establish the safety of vaginal delivery for patients with Eisenmenger syndrome or with uncorrected DORV and pulmonary hypertension.
Published guidance and reviews emphasize the high maternal risk in Eisenmenger syndrome and recommend individualized, multidisciplinary management in centers able to provide comprehensive cardiac, obstetric, anaesthetic, and neonatal support. The authors note sparse evidence addressing pregnancy management when uncorrected DORV coexists with Eisenmenger physiology.
The case documents a favourable short-term maternal and neonatal outcome following induced vaginal delivery in a patient with probable Eisenmenger physiology and suspected DORV, with maternal intensive care monitoring, blood transfusion for postpartum anaemia, and a liveborn neonate admitted to neonatal intensive care. The report underscores significant diagnostic and reporting gaps — incomplete haemodynamic and anatomic characterization, and limited perioperative and neonatal details — that prevent causal conclusions about the safety of vaginal delivery in such high-risk patients. Further detailed reporting and data from larger series are required to inform practice in pregnancies complicated by pulmonary hypertension and complex congenital heart disease.