A 36-year-old gravida 2, para 1 Caucasian woman presented at 9 weeks of gestation with headaches but normal blood pressure. She had a past medical history of an in vitro fertilization pregnancy complicated by preeclampsia at 27 weeks of gestation (birth weight 1900 g) and infrarenal aortic stenosis. In the current pregnancy, she received aspirin and calcium as preeclampsia prophylaxis, remained normotensive throughout pregnancy, and was delivered by elective cesarean section at 37 weeks without complications.
Laboratory investigations for preeclampsia during her pregnancy revealed low-grade proteinuria (urine protein/creatinine ratio 40 mg/mmol) and normal renal and liver function. A vasculitic screen revealed a normal C-reactive protein (3.8 mg/L); mildly elevated erythrocyte sedimentation rate (ESR) (16 mm/h); and absence of antinuclear antibodies, antineutrophilic cytoplasmic antibodies, anti-double-stranded DNA antibodies, and antiphospholipid antibodies. The estimated fetal weight at a 34-week ultrasound was in the 94th percentile, and placental vascular resistance was normal.
The differential diagnoses for the major finding of significant infrarenal aortic stenosis included congenital abdominal coarctation, Takayasu’s arteritis, fibromuscular dysplasia, aortic neurofibromatosis, aortic tuberculosis, and radiation aortitis. The presence of a well-developed collateral vasculature suggested a chronic aortopathy. In the absence of a clinical history or signs of neurofibromatosis, tuberculosis, or radiation exposure, as well as little evidence of active inflammation, the diagnosis of chronic abdominal aortopathy from congenital abdominal aortic coarctation, fibromuscular dysplasia, or inactive Takayasu’s arteritis was made.
The woman received aspirin and calcium as preeclampsia prophylaxis until 36 weeks of gestation, as well as insulin for gestational diabetes. She remained normotensive throughout pregnancy without requiring antihypertensive medications and delivered a healthy female infant weighing 3185 g by cesarean section at 37 weeks without complications. No regular medications were continued during the postpartum period.