We have a patient on the high risk OB service right now that is just breaking my heart. But in reality, it is her heart that is broken.
She is a young Hispanic woman, and this is her first pregnancy. She went to the doctor for a check-up - the first one during the pregnancy (possibly the first doctor visit in a long, long time - at least, I hope so). The doctors noticed a murmur. A bad murmer. A cardiac echo showed that she has a hole in her heart (an atrial septal defect for those in the know). This is something that has almost certainly been there since she was born. Something - perhaps the pregnancy, perhaps time - has caused the blood flow to back up into her lungs, causing pulmonary hypertension (aka Eisenmenger's syndrome). Severe pulmonary hypertension. Plus a bit of severe pulmonic stenosis and severe mitral regurgitation on top of that. In real person terms: she is about one sneeze away from going into total heart failure. And she is pregnant.
Doing a little research online shows me that the official recommendation for women with Eisenmengers is sterilization. AKA no babies. None. Ever. Why? Because the mortality - that means death - rate is up to 50%. Half of these women who get pregnant will die, either before, during or after they give birth.
This young woman had no clue.
And she still didn't as of a few hours ago when I saw her. Because she speaks Spanish, and you need a REALLY good translator to go in to tell someone that we need to deliver her baby at just over 6 months gestation otherwise she may die. She may die anyway.
No one knows what to do with her. We'll probably have to transfer her to another university hospital. One that can do heart transplants, so that she can get added to the list.
It just breaks my heart.
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