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Keywords:

  • Tin Man;
  • ICD/pacemaker;
  • tetrology of fallot;
  • abruption;
  • pregnancy and cardiac anomalies

Poster Presentation

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  2. Poster Presentation

Background

Cardiac disease occurs in approximately 1% of all pregnancies. Tin Man syndrome, though rare, is a disorder encompassing physical and/or electrophysiological cardiac mutations that may present at any time in life. Historically, women with cardiac anomalies were discouraged from pregnancy. While medical advancements have increased the possibility of pregnancy in this population, they may also be minimizing the perception of risk and severity of complications for the mother and infant. This presentation will cover the challenges of dealing with the multidisciplinary care of a pregnant woman with an implantable cardioverter defibrillator ICD pacemaker and neonate with Tetrology of Fallot.

Case

A 41-year-old gravida 7, para 3 with a rare genetic disorder causing cardiac anomalies, NKX2.5 (otherwise known as the “Tin Man” gene), began prenatal care at 16 weeks for an unplanned pregnancy with unknown last menstrual period. Maternal complications of pregnancy included severe itching due to cholestasis, vaginal bleeding, and suspected chronic abruption. A fetal echocardiogram at 24 weeks confirmed Tetrology of Fallot with pericardial effusions. She was hospitalized for vaginal bleeding at 32 weeks and again at 33 to 36 weeks gestation for vaginal bleeding, which raised suspicions of chronic abruption. The patient was challenged by several test findings and she struggled to trust herself as well as care givers. The strong family history of varied cardiac anomalies increased her anxiety. Several social factors, marital discord, family dynamics, financial stress, and spiritual distress presented unique challenges far exceeding the difficulty of her physical management. The need for a holistic approach to care for this patient and her family became evident as well as the educational needs of the staff caring for this family.

Conclusion

Regardless of specialty, nurses must be aware of developing trends in all fields as multifactorial complications present themselves in complex patients. Both maternal and neonatal complications may be compounded by the physiological alterations and risks innate to pregnancy. As a trusted resource and advocate, nurses must take a holistic approach to care by identifying and providing the necessary resources. The collaboration of varied services and medical specialties was necessary to provide consistent care, comfort and reassurance for this patient and her family. The teamwork inspired staff to brainstorm and debrief, resulting trust among caregivers and the patient and providing the basis for safe, compassionate care.