We report the case of a 32-year-old primiparous patient referred to the Cardiology Department for the management of hypertension at 28 weeks’ gestation. She has a history of asthma and acute rheumatic fever (ARF) in childhood. At the age of 17, she underwent percutaneous closure of a large atrial septal defect (ASD) of the ostium secundum type. Clinical examination revealed grade 1 hypertension (BP = 157/96 mmHg) and signs of right-sided heart failure. Echocardiography revealed pulmonary arterial hypertension with a pulmonary artery systolic pressure (PASP) of 73 mmHg, dilatation of the right cardiac chambers and the inferior vena cava, and grade 2 mitral regurgitation. Further investigation led to a diagnosis of scleroderma, confirmed by histopathological examination of a skin biopsy. Treatment was initiated with furosemide tablets (40 mg/day), spironolactone (50 mg/day), sildenafil (50 mg/day), and prednisolone (2.5 mg/day). Delivery was scheduled at 34 weeks’ gestation by caesarean section, resulting in a live female infant who cried immediately and weighed 2400 g. The postoperative course was uneventful, with both the baby and the mother doing well. Bosentan and methotrexate combined with folic acid were initiated postpartum.
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