Idiopathic pulmonary fibrosis (IPF) necessitating therapeutic midtrimester abortion: a case report

A 35-year old multiparous lady was admitted at 19 weeks of pregnancy with rapid onset of dyspnoea which progressed to grade III in 2 months. She was diagnosed as a case of idiopathic pulmonary fibrosis (IPF). She had a vital capacity of 1.25 l, 46.5% of predicted and PaO2 of 60 mmHg at rest, dropping to 35 mmHg on mild exercise testing. She did not respond to prednisolone 40 mg daily given orally for one month. In view of lack of improvement, therapeutic abortion was carried out at 24 weeks by abdominal hysterotomy combined with tubal ligation. Subsequent to termination of pregnancy, her clinical status and pulmonary function improved markedly and she had only grade I dyspnoea 30 months later without corticosteroids. Effect of pregnancy on interstitial lung disorders especially IPF is not yet clear because of extreme rarity of their association. Therapeutic abortion should be seriously considered in patients who cannot increase their oxygen consumption 3 times normal without uncorrectable hypoxaemia.