Case Report

Severe Aortic Stenosis Concealed by a Negative History in Pregnancy: A Case Report Emphasizing the Diagnostic Cornerstones of History and Physical Examination

Abstract

Pregnancy concurrent with severe underlying cardiac disease presents a substantial risk to maternal and fetal well-being. Despite routine antenatal screening, patients may occasionally deny or be unaware of critical cardiac histories, complicating perioperative management and leading to catastrophic decompensation. We report the case of a 22-year-old primigravida admitted for labor with intrauterine fetal demise (IUFD). The initial history was non-contributory, and the physical examination was unremarkable. Following an uncomplicated delivery and regional analgesia, the patient experienced sudden hemodynamic collapse, seizure, and pulmonary edema, necessitating emergent intubation and intensive care. Subsequent echocardiography revealed previously undiagnosed severe aortic stenosis (AS) with a mean pressure
gradient of approximately 100 mmHg. This case highlights how severe, compensated pathology can be masked by patient denial, underscoring the indispensable role of a meticulous history and physical examination as the primary diagnostic tool in obstetric anesthesia, regardless of self-reported symptoms.

[1] Roos-Hesselink JW, Zühlke L, Bauersachs J, BlomstromLundqvist C, Cifkova R, De Bonis M, et al. ESC Scientific
Document Group. 2023 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J.
2023;44(39):3965-4089.
[2] Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstrom-Lundqvist C, Cifkova R, De Bonis M, et al. 2018 ESC
Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3138-97. https://
doi.org/10.1093/eurheartj/ehy340
[3] Hunter S, Robson SC. Adaptation to pregnancy and haemodynamic changes. BMJ. 1992;305(6857):783-6.
[4] Butwick AJ, Paternoster JL. Anesthetic and obstetric management of the parturient with cardiac disease. Curr Opin
Anaesthesiol. 2012;25(3):289-96.
[5] Dierdorf SF, Walton JS. Anesthetic management of the parturient with cardiovascular disease. In: Chestnut DH,
Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, editors. Chestnut’s Obstetric Anesthesia: Principles and Practice. 6th ed. Philadelphia: Elsevier; 2020. p. 770-803.
[6] Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515-21. https://doi.org/10.1161/
hc3001.093437
[7] Nanna M, Bier L, D’Souza R, DeFaria Yeh D, Ginns J, Hollier LM, et al. Management of Aortic Stenosis in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. 2024;149(3):e185-e199.
[8] Al-Rawahi Y, Jaggernauth S, Lim C, Silversides C, Sermer M, Siu S, et al. Aortic stenosis in pregnancy: A review of current management. J Obstet Gynaecol Can. 2020;42(10):1243-53.
[9] Zahaka A, Al-Othmani R, Al-Qudimat R, Al-Ani A. Severe Aortic Stenosis in a Parturient with Undiagnosed Rheumatic
Heart Disease: A Case Report. Case Rep Anesthesiol. 2021;2021:6650429.
[10] Silversides CK, Grewal J, Mason J, Sermer M, Kiess M, Rychel V, et al. Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study. J Am Coll Cardiol. 2018;71(21):2419-30. https://doi.org/10.1016/j.jacc.2018.02.076
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IssueVol 10 No 4 (2025): July-August QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v10i4.21108
Keywords
Anesthesia Obstetrical Cardiopulmonary arres
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How to Cite
1.
Masaeli M, Ghobadi S, Rezaie Hoseinabadi MK. Severe Aortic Stenosis Concealed by a Negative History in Pregnancy: A Case Report Emphasizing the Diagnostic Cornerstones of History and Physical Examination. CRCP. 2026;10(4):160-166.