Pregnancy and pulmonary arterial hypertension: a case series and literature review

Yang, Jenny; Fernandes, Timothy; Kim, Nick H.; Poch, David; Kerr, Kim M.; Lombardi, S; Melber, Dora J.; Kelly, Thomas F.; Papamatheakis, Demosthenes G.

doi:10.1016/j.ajogmf.2021.100358

Cited by 20 publications

(24 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Pregnancy-induced hypertension syndrome (PIH) is a common pregnancy syndrome that could cause varying degrees of maternal and fetal organic damage and even endanger their lives [ 1 , 2 ]. Its development is mostly seen after 20 weeks of gestation and is characterized by hypertension and other systemic dysfunctions, with a prevalence of 5%.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound of Fetal Cardiac Function Changes in Pregnancy-Induced Hypertension Syndrome

et al. 2022

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

Pregnancy-induced hypertension syndrome (PIH) is a common pregnancy syndrome that could cause varying degrees of maternal and fetal organic damage and even endanger their lives. This study aimed to investigate ultrasound of fetal cardiac function changes in PIH. Totally 40 cases of gestational hypertension admitted to Cangzhou Central Hospital between October 2018 and September 2019 were enrolled in the hypertension group, and 40 women with healthy pregnancies during the same period were assigned to the normal group. Ultrasound results showed that PIH was associated with a significantly higher fetal cardiac septal thickness, fetal left ventricular end-diastolic area and end-systolic area, fetal right ventricular end-diastolic area and end-systolic area, fetal left ventricular systolic fraction 1 (VSF1), fetal left ventricular systolic fraction 2 (VSF2), fetal right VSF1, and fetal right VSF2 versus healthy pregnancy. The PIH fetuses had significantly lower neonatal weights versus healthy fetuses. Newborns of hypertensive pregnancies have larger hearts, faster heart rates, increased cardiac contractility, and lower weights versus newborns of healthy pregnancies.

show abstract

Section: Introductionmentioning

confidence: 99%

Ultrasound of Fetal Cardiac Function Changes in Pregnancy-Induced Hypertension Syndrome

et al. 2022

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

show abstract

“…Yang et al [ 6 ] reported on 7 patients and 7 pregnancies, with 5 of the 7 having known PAH before pregnancy. The average mPAP was 59 mmHg and PVR 11.4 WU.…”

Section: Discussionmentioning

confidence: 99%

“…Breast feeding is sometimes encouraged, but data supporting this are limited, and some recommend against this [ 6 , 14 , 23 ]. If the mother warrants diuretic, this may affect the milk supply [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary arterial hypertension (PAH) is hemodynamically defined by the presence of pulmonary hypertension (PH) (mean pulmonary artery pressure greater than 20 mmHg), a pulmonary arterial wedge pressure ≤15 mmHg, and pulmonary vascular resistance (PVR) ≥3 mmHg/L/min. PAH carries high morbidity and mortality during pregnancy, with mortality rates reported as high as 30–50% [ 1 , 2 , 3 , 4 , 5 , 6 ]. Prognosis has improved in recent years given the introduction of new PAH medications in the field, but it remains one of the highest risk medical conditions for both mother and baby; in fact, according to guidelines, pregnancy is contraindicated in patients with PAH [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center

Vaidya

Oliveros

Mulla

et al. 2022

JCDD

View full text Add to dashboard Cite

(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension (PH) center from 2013 to 2021. (3) Results: seven pregnancies in six women with PAH, ranging from low to high risk and 21 to 37 years old. Half had known pre-existing PAH before pregnancy. One had a multifetal gestation, and one was pregnant twice under our care. PH medical therapy and serial clinical assessment throughout pregnancy were implemented with focused attention on optimizing right heart function. Delivery was planned by a multidisciplinary team involving PH cardiology, maternal fetal medicine, and obstetric anesthesiology. Patients delivered between 31 and 40 weeks of gestation; five of the seven were via cesarean section. All received regional anesthesia and were monitored in the PH intermediate step-down unit after delivery until discharge. In all cases, delivery was without complications with excellent outcomes for the mother and child. (4) Conclusions: Multidisciplinary and tailored management of PAH in pregnancy, emphasizing optimized right heart function prior to delivery, can result in excellent clinical outcomes in a referral PH center.

show abstract

“…Pulmonary arterial hypertension (PAH) often leads to acute right ventricular failure, circulatory collapse and death during in pregnancy [1,2]. The incidence of PAH in pregnancy has ranged from less than 1% to 8%, and maternal mortality (9%-33%) is highest among pregnancies coexisting with cardiac disease [3][4][5][6]. The manifestations of undiagnosed PAH during pregnancy are difficult to distinguish from the normal physiologic changes of pregnancy, such as palpitations, exertional dyspnea and lower extremity edema [7].…”

Section: Introductionmentioning

confidence: 99%

Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages

et al. 2021

View full text Add to dashboard Cite

The mortality rate of pulmonary hypertension in pregnancy is 25%–56%. Pulmonary arterial hypertension is the highest incidence among this group, especially in young women. Despite clear recommendation of pregnancy avoidance, certain groups of patients are initially diagnosed during the gestational age step into the third trimester. While the presence of right ventricular failure in early gestation is usually trivial, it can be more severe in the late trimester. Current evidence shows no consensus in the management and serious precautions for each stage of the pre-, peri- and post-partum periods of this specific group. Pulmonary hypertension-targeted drugs, mode of delivery, type of anesthesia, and some avoidances should be planned among a multidisciplinary team to enhance maternal and fetal survival opportunities. Sudden circulatory collapse from cardiac decompensation during the peri- and post-partum phases is detrimental, and mechanical support such as extracorporeal membrane oxygenation should be considered for mitigating hemodynamics and extending cardiac recovery time. Our review aims to explain the pathophysiology of pulmonary arterial hypertension and summarize the current evidence for critical management and precautions in each stage of pregnancy.

show abstract

Pregnancy and pulmonary arterial hypertension: a case series and literature review

Cited by 20 publications

References 56 publications

Ultrasound of Fetal Cardiac Function Changes in Pregnancy-Induced Hypertension Syndrome

Ultrasound of Fetal Cardiac Function Changes in Pregnancy-Induced Hypertension Syndrome

Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center

Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages

Contact Info

Product

Resources

About