Contrasting Outcomes in Two High-Risk Pregnancies: A Clinical Experience in Diagnostic Delay vs. Multidisciplinary Success

Maliheh  Ghasemi Tirtashi; Aghdas Ebadi Jamkhane; Marzieh  Zamaniyan; Negin   Nezhad Naderi; Keihan Shabankhani

doi:10.18502/crcp.v10i1.19480

Maliheh Ghasemi Tirtashi Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Aghdas Ebadi Jamkhane Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Marzieh Zamaniyan Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Negin Nezhad Naderi Department of Anesthesiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Keihan Shabankhani Student Research Committee, Mazandaran University of Medical Science, Sari, Iran.

DOI: https://doi.org/10.18502/crcp.v10i1.19480

Keywords: High-risk Pregnancy, Congenital heart disease, Breast cancer, Chemotherapy, Multidisciplinary management

Abstract

Pregnancy significantly alters the clinical presentation of various diseases, often masking or mimicking symptoms of serious underlying conditions. In high-risk pregnancies, overlooking nonspecific symptoms may delay the diagnosis of life-threatening disorders, resulting in poor maternal and fetal outcomes. This report describes two rare cases of pregnancy in women with complex medical histories. The first patient, a 34-year-old at 30 weeks’ gestation, was diagnosed with invasive ductal breast cancer with extensive bone and pulmonary metastases, as well as hypercalcemia-induced renal failure. Despite emergency dialysis, respiratory support, spinal anesthesia for delivery, and coordinated care from nephrology, endocrinology, obstetrics, and anesthesiology teams, her condition worsened postpartum. She developed respiratory acidosis and decreased consciousness, and required intubation. Although initially stabilized and her malignancy confirmed via biopsy, she progressed to multi-organ failure and died from asystole 5 days postpartum, on January 22, 2025, despite resuscitation. The second patient, also 34, had a history of repaired congenital heart disease and right-sided invasive ductal carcinoma. Against medical advice, she pursued a high-risk spontaneous pregnancy, closely monitored by a multidisciplinary team. Her hypertension and gestational diabetes were managed with medications and insulin, respectively. At 37 weeks, she underwent elective cesarean section at a tertiary center, delivering a healthy boy with normal weight and Apgar scores of 9 and 10. She was discharged hemodynamically stable from the ICU, approved for breastfeeding, and scheduled to start chemotherapy on March 10, 2025. These contrasting cases demonstrate how outcomes in high-risk pregnancies are profoundly influenced by timely diagnosis and coordinated care. Nonspecific symptoms during pregnancy should prompt thorough evaluation, especially in the absence of antenatal care. A structured, team-based approach can significantly improve maternal and neonatal outcomes, even in medically complex scenarios.