Nightmare pregnancy complicated with preeclampsia, severe depression and hyperemesis gravidarum

Objective. A challenging case of medical management in a pregnancy complicated with severe anxiety-depression syndrome and persistent hyperemesis.
Materials and Methods. 43 years old pregnant woman with pre-existent grade 3 hypertension presented for uncontrolled blood pressure under 1 g of Methyldopa, severe intolerance at Nifedipin, hyperemesis and high indexes of pulsatility on uterine arteries ultrasound. She was obese and diagnosed with severe anxiety and depression under treatment temporarily stopped with sertraline. Pregnancy was obtained by IVF (tubar infertility).
Results. Pregnancy was a roller coaster requiring team management and challenging therapeutic decisions among resis- tant hypertension, vaginal bleeding, persistent hyperemesis, worsening psychiatric disorder, anaemia and pharmacological interactions. Constant multidisciplinary monitoring by telemedicine offered the chance to give birth by C-section at 37 weeks (for late preeclampsia) to a 3040 g newborn, APGAR 5-8 with mild pulmonary artery stenosis and favourable evolution.
Conclusions. Selection, dosage and timing of antihypertensive treatment is challenging with associated hyperemesis gravidarum. Management of depression and anxiety along pregnancy requires attention although standardized screening psychiatric methods are lacking, and prevention of post-partum depression is the essential goal. Frequent monitoring a hypertensive pregnant by telemedicine gives per se a favourable outcome.