A 31-year-old pregnant woman with progressive exertional dyspnea and differential cyanosis.

A 31-year-old woman presented at a community hospital with an episode of hemoptysis at the 22nd week of pregnancy. She had experienced progressive exertional dyspnea since the first trimester of her pregnancy. Her medical history was notable for a “heart condition” diagnosed at birth for which the patient had never sought follow-up care. In the evaluation of her hemoptysis, her physicians performed an echocardiogram that demonstrated pulmonary hypertension. She was referred to the National Taiwan University Hospital for the management of high-risk pregnancy. An admitting cardiologist prescribed diltiazem and indapamide for pulmonary hypertension, but her dyspnea did not improve. She was discharged from the hospital for outpatient care, and was noted to have a breech presentation and intrauterine growth retardation at the 27th week of pregnancy. Early delivery was recommended, and corticosteroids were administered to enhance fetal lung maturity. Subsequently, she was admitted for elective cesarean section at the 31st week of pregnancy.