Correlation of echocardiographic probability of pulmonary hypertension with maternal outcomes in pregnant women with elevated right ventricular systolic pressure

Abstract

Introduction The use of echocardiography to evaluate the probability for pulmonary hypertension (PH) in pregnant women has not been reported or correlated with outcomes. We hypothesized that in women with elevated right ventricular systolic pressure (RVSP) on echocardiography first identified during pregnancy, those with low probability for PH would have fewer major adverse cardiac events (MACE). Methods We performed a retrospective cohort study of pregnant women with RVSP >35 mm Hg on echocardiogram first identified during pregnancy. Women were classified as intermediate‐high probability for PH (HP) or low probability for PH (LP) based on simplified European Society of Cardiology echocardiographic criteria. Maternal cardiac, obstetric, and fetal outcomes were assessed. Results A total of 77 women met inclusion criteria (mean age 30 ± 5 years), with 45 (58%) classified as HP and 32 (42%) as LP. There were 21 (27%) women who experienced MACE, more commonly in the HP cohort (HP 18 (40%) women vs. LP 3 (9%) women, P = .01). The echocardiographic criteria for intermediate‐high probability of PH identified women at risk for MACE with 85% sensitivity and 52% specificity. The negative predictive value for MACE in women meeting low echocardiographic probability for PH criteria was 91%. Conclusions In women with elevated RVSP on echocardiography first identified during pregnancy, those with low echocardiographic PH probability are at significantly lower risk for MACE during pregnancy, though the risk is not eliminated. This may be useful to risk stratify pregnant women with suspected PH, guiding tertiary care referral and invasive catheterization.

Early Assessment of Cardiac Function by Echocardiography in Patients with Gestational Diabetes Mellitus

“…The incidence of polyhydramnios was 10 times higher than that of nondiabetes pregnant women. The incidence of macrosomia is significantly increased, the probability of dystocia, birth canal injury, and surgical delivery is increased, and the labor process is prolonged, which is prone to postpartum hemorrhage [ 6 ]. In addition, it is prone to diabetes ketoacidosis and infection related to gestational diabetes, such as vulvovaginal candidiasis, pyelonephritis, asymptomatic bacteriuria, puerperal infection, and mastitis [ 7 ].…”