Managing Unrepaired Tetralogy of Fallot in Pregnancy: A Rare Case Defying Standard Cardiac Guidelines

Tetralogy of Fallot (TOF) is the commonest cyanotic congenital cardiac defect. Uncorrected TOF in adults, especially during pregnancy, is uncommon and presents significant hazards to both mother and fetus.

We present a case of a 28-year-old lady with uncorrected cyanotic TOF, gravida 4, para 1 + 3 at 22 weeks of gestation, who presented to our multidisciplinary cardio-obstetric team. She presented with cyanosis, exertional dyspnea, and oxygen saturation in the range of 70% to 80%. Echocardiography revealed the classic features of TOF, such as a large ventricular septal defect and severe pulmonary stenosis. An emergency preterm birth was performed at 28 weeks due to maternal instability. The baby, admitted to the neonatal intensive care unit, was released after 14 days.

Uncorrected TOF seldom allows for survival to reproductive age. Research indicates worse maternal-fetal outcomes in such cases. This instance underscores the significance of prompt diagnosis and diligent management by a multidisciplinary cardio-obstetric team for a better prognosis.

Uncorrected TOF during pregnancy is uncommon but can be effectively managed with prompt, multidisciplinary cardio-obstetric collaborative intervention.