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2017-01-15  Case of the week # 438  © Lilit Hovsepyan

Answer to the case of the week # 438
February 2, 2017 - February 16, 2017

Lilit Hovsepyan, MD.
Erebouni Medical Center, Armenia.

Case report

A 22-year old patient (G1P0) without consanguinity, was referred to our unit at 33 weeks of gestational age, two days after treatment in another hospital with nifedipine 40 mg. daily and betametazone orally 24 mg. because of regular uterine contractions. Our first ltrasound examination didn't find any anomaly.

After this examination 4 days later she had a flu, with high tempertaure, and paracetamol 2 tabs. and one tab of ibuprofen were administrated. She was sent to our hospital again after recovery 3 weeks later at 36 weeks of age. 
During second and third ( 2 days later) exams we found the following findings:
  • Enlarged pulmonary artery
  • Cardiomegaly
  • Tricuspid regurgitation and pulmonary regurgitation 
  • Absent flow in DA
  • Enlarged PA branches

Two days later an emergency cesarean was performed because of non-reassuring fetal heart rate. The preterm baby was born and weighted 2460 gr. Postnatal echocardiography show a premature closure of the ductus arteriosus, pulmonary hypertension and cardiomegaly. No other anomalies were found. 

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