A 27-year-old G3P1011 presented at 34 weeks gestation with dyspnoea, which she also reported in her prior pregnancy. Her dyspnoea was accompanied by exertional hypoxemia. After excluding other etiologies of hypoxia such as cardiac anomalies and pulmonary embolism, arterio-venous shunting became the working diagnosis. She was treated successfully with ambulatory oxygen therapy and her symptoms resolved spontaneously after delivery with a good maternal and fetal outcome. Although we were unable to confirm a diagnosis of arteriovenous malformation of hereditary hemorrhagic telangiectasia, we remain suspicious that this is the underlying cause of her symptoms. Review of hereditary hemorrhagic telangiectasia identifies concerns regarding screening and obstetric management. Hereditary hemorrhagic telangiectasia is a rare genetic disease that may present as transient exertional hypoxemia in the third trimester of pregnancy. Pregnancy with arteriovenous shunting can be managed with symptomatic treatment along and careful attention to existing obstetric and anesthetic guidelines.
Matthew Janssen, Kimia Menhaji, Dominic Marchiano and Lauren Catalano
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