A 30-year-old primigravida, diagnosed as a case of Macleod syndrome for the past 12 years, was supervised in our antenatal clinic. She had received antitubercular drugs for pulmonary tuberculosis at 8 years of age; and later on, intercostal chest tube drainage for empyema thoracis at her native place. She had recurrent episodes of fever, breathlessness and cough when she had presented in the Department of Pulmonary Medicine at our institute. Chest X-ray revealed old lesions of pulmonary Koch's with cicatrisation collapse. Computed tomographic scan showed decreased attenuation of right lung and basal segment of left lung, diminished right hilar vessels and bronchiectasis, consistent with the Swyer-James syndrome.
She had regular follow-up in our clinic. General physical examination showed tracheal deviation to right side. Chest auscultation revealed diffuse crepitations in right lung fields. Spirometry revealed moderate obstruction with FEV1 (forced expiratory volume in one second) IOL, FEV1 / FVC (forced vital capacity) 69%. Maternal and fetal surveillance was uneventful. She was normotensive till 34 weeks of gestation, when she developed severe preeclampsia and features of imminent eclampsia, for which labor was induced with oxytocin. Intrapartum arterial blood gas monitoring on room air showed PO2 77 mmHg, PCO2 28 mmHg, pH of 7.40, O2 saturation 97.5%. She developed non-reassuring fetal heart rate patterns, and a live-born male baby weighing 1,830 g with normal Apgar score was delivered by emergency cesarean section under spinal anesthesia. Broad-spectrum antibiotics were given for surgical intervention, as well as pulmonary infection prophylaxis. Intraoperative and postoperative period was uneventful, and both the mother and the child were discharged in a satisfactory condition.