Gives birth to her baby girl despite a bad heart

A fragile heart, marked by complex congenital heart disease and severe decompensation, but extraordinary strength. The story is that of Sara (fictitious name to protect privacy) who, against all odds, managed to give birth to her baby girl. The patient, a 31-year-old woman with severe heart failure and severe pulmonary hypertension, managed to carry her pregnancy to term thanks to the teamwork of multidisciplinary teams at the Federico II University Hospital in Naples. This was an even more extraordinary achievement when one considers that Sara had already been treated as a newborn and today-despite the picture of severe heart failure with severe pulmonary hypertension-she gave birth to a healthy baby girl.

What seemed impossible was made possible by the synergistic work of a multidisciplinary team that followed the patient with scientific rigor and human attention during all phases: the prenatal course, delivery and the delicate postoperative period.

"I will forever thank them, they were all extraordinary and it is only thanks to them that I am here today and can embrace my little girl," commented Sara movedly.

Pregnancy in women with severe heart failure and pulmonary hypertension is considered one of the highest risk conditions in obstetrics: the risk of maternal, fetal and neonatal adverse events is very high, with the possibility of acute cardiovascular complications and adverse outcomes for the mother and fetus. Transferred at 29 weeks of gestation to the AOU Federico II from another region and by helicopter transport, the patient was taken care of through a dedicated pathway, activated in collaboration between the Complex Operating Units of Cardiology, Obstetrics and Gynecology, Anesthesia and Resuscitation, Neonatology, Cardiac Surgery and Clinical Psychology, with the support of external experts.

"Working in a multidisciplinary team has allowed us to integrate different skills to best protect the health of mother and daughter. Every birth represents an extraordinary event; in the most complex situations like this one, its value takes on an even deeper meaning," the words of Giuseppe Bifulco, Director of the UOC of Obstetrics, Gynecology and Sterility Center at AOU Federico II.

To minimize risks, the multidisciplinary team planned a cesarean delivery in a high-tech cardiac operating room, equipped with advanced monitoring equipment and with the availability of ready-to-use extracorporeal circulatory support systems (ECMO), and with the simultaneous presence of cardiologists, anesthesiologists, gynecologists, cardiac surgeons, neonatologists and resuscitators: a team effort in which each had a precise, coordinated and integrated role. The birth was successful: the baby girl, in good clinical condition, was immediately handed over to neonatologists for initial care. The mother was transferred to the intensive care unit, where she faced the critical postpartum hours with constant monitoring and targeted pharmacological support. Along with therapies, constant psychological support was provided to the patient and her family. Awareness of the risks, fears and hopes represented a huge emotional burden, which was faced together thanks to the presence of professionals who supported the woman as a patient, but above all as a person and as a mother.

"This result," said Professor Giovanni Esposito, Director of the UOC of Cardiology, Hemodynamics and NICU, "is the result of the expertise of our professionals and the ability to work as a team. Our patient was facing a very high risk, but meticulous preparation and continuous monitoring allowed us to arrive at this positive outcome."

The birth of this baby girl, which took place right on World Heart Day, is a symbol of science, expertise and humanity: a demonstration that, even in the face of extreme clinical conditions, medicine can turn risk into life and fear into hope.

"This experience represents not only a clinical success, but also a replicable organizational model for the management of high-risk pregnancies. In addition, it reinforces AOU Federico II's commitment to develop clinical pathways that are increasingly targeted to women, especially those with heart disease and severe comorbidities," stresses Elvira Bianco, General Director of AOU Federico II.