Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China

Zhang, Jinglan; Lu, Jiakai; Zhou, Xin; Xu, Xuefeng; Ye, Qing; Ou, Qitan; Li, Yanna; Huang, Jiapeng

doi:10.1053/j.jvca.2018.01.043

Cited by 32 publications

(24 citation statements)

References 32 publications

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“…Once the cervix is dilated, if labor has not commenced, judicious use of lowdose oxytocin infusion is begun to stimulate uterine contractions. Oxytocin can induce systemic vasodilatation and pulmonary vasoconstriction and is discouraged by some authors [71].…”

Section: Deliverymentioning

confidence: 99%

Pulmonary Hypertension Complicating Pregnancy

et al. 2021

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Purpose of review This study aims to describe the pathophysiology of pregnancy in pulmonary hypertension (PH) and review recent literature on maternal and fetal outcomes. Recent findings There is an increasing number of pregnant women with PH. Maternal mortality in pulmonary arterial hypertension (PAH) ranges from 9 to 25%, most commonly from heart failure and arrythmias. The highest risk of death is peri-partum and post-partum. Fetal/neonatal morbidity and mortality are also substantial. There are high rates of prematurity, intrauterine growth retardation, and preeclampsia. Women should be referred to expert centers for management. Combination PAH therapy with parenteral prostacyclin and a phosphodiesterase type V inhibitor is recommended. Induced vaginal delivery is preferred, except in cases of severe heart failure or obstetric indications for cesarean section. Summary Despite advances in management, pregnancy in PAH remains a high-risk condition and should be prevented.

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Section: Deliverymentioning

confidence: 99%

Pulmonary Hypertension Complicating Pregnancy

et al. 2021

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“…Thus, the incidence of death after delivery, especially within 1 week after delivery, is high; however, this is inconsistent with clinicians' previous understanding of the development of this disease. Clinical data have shown that PAP increases in most patients who die within 1 week after delivery, especially patients with severe PAH or idiopathic PAH (IPAH) (13,14). Theoretically, the circulatory system gradually stabilizes during this period, but PAP further increases.…”

Section: Original Articlementioning

confidence: 99%

“…The MCT-induced PAH rat model is a classical animal model that mimics several key aspects of human PAH, including vascular remodeling, smooth muscle cell proliferation, e n d o t h e l i a l d y s f u n c t i o n , i n f l a m m a t o r y c y t o k i n e upregulation, and right ventricle failure and requires only a single drug injection (18)(19)(20). It also precisely simulates the pathophysiological changes that occur in IPAH (21), which is the most severe type of PAH in pregnancy patients and causes the highest mortality (13,22). We established a new animal model-a pregnant rat model of MCT-induced PAH-based on this model.…”

Section: Rat Model Of Pah In Pregnancymentioning

confidence: 99%

Postpartum pulmonary circulation in pregnant rats with monocrotaline-induced pulmonary arterial hypertension

Jin

et al. 2020

J Thorac Dis

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Background: This is the first study to evaluate changes in postpartum pulmonary circulation in a novel pregnant rat model of monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Methods: Female rats were randomly divided into two groups: the MCT-treated pregnant group, in which rats were injected with MCT (40 mg/kg) at the age of 7 weeks, and the pregnant group, in which rats were injected with the same volume of 0.9% saline at the same age. Rats from both groups were mated at the age of 9 weeks. General condition information, hemodynamic data and pulmonary tissues were collected from pregnant rats from the two groups on the 18th day after successful mating (T1) and the 1st (T2), 3rd (T3), and 7th days after delivery (T4). Results: The MCT-treated pregnant group exhibited a greater mean pulmonary artery pressure (mPAP) (P<0.01) and Fulton's Index (P<0.01) than the pregnant group at each time point. Lung tissues from the MCT-treated pregnant group showed pulmonary vascular hyperplasia and occlusive changes. The mPAP and the occluded pulmonary artery density in the MCT-treated pregnant group increased after delivery (P<0.01) and significantly increased at T3 compared with T2 (P<0.05) but was not further increased at T4 (P>0.05).Conclusions: Pregnant rats with PAH exhibited increased mPAP after delivery accompanied by a significant increase in the occluded pulmonary artery density, which may have contributed to the increased mortality rate of pregnant rats with PAH after delivery.

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“…Most of the test samples are urine (Dong & Liu, 2009) and blood (Jedrychowski et al, 2013). However, there are relatively few studies on the prenatal exposure level of PAHs and their carcinogenic toxicity in pregnant women (Adetona et al, 2013;Zhang et al, 2018), especially in China (Xu et al, 2017;Yang et al, 2010). The presence of some complex mixtures may have synergistic or antagonistic effects on PAH internal exposure level and the risk assessment of carcinogenicity.…”

Section: Introductionmentioning

confidence: 99%

Polycyclic aromatic hydrocarbons residues and the carcinogenic risk assessment to pregnant women in Nantong, China using QuEChERS method and HPLC—A pilot case study

Guo

Shi

Gu³

et al. 2021

Biomedical Chromatography

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A high-performance liquid chromatographic method with a modified QuEChERS extraction for the determination of polycyclic aromatic hydrocarbons (PAHs) in blood serum was developed to investigate the internal exposure level and the carcinogentic toxicity contribution rate of PAHs for pregnant women in Nantong, China. Venous blood (n = 48) was collected in the local hospital and the internal exposure level of 16 PAHs and the contribution rate of carcinogenicity to pregnant women were analyzed. Among all of the detected PAHs, the detection rate of pyrene (77.08%) was the highest, followed by naphthalene (64.58%) and benzo[a]anthracene (BaA, 45.83%). The carcinogenicity contribution rate of BaA (37.37%) was the highest, followed by fluorene (32.96%) and acenaphthylene (22.01%). The results showed that many kinds of carcinogenic PAHs can be detected in the serum of pregnant women in Nantong city, among which BaA should be paid most attention because of its high internal exposure level and carcinogenic risk. Meanwhile, the origins of general PAHs in serum samples were analyzed using the characteristic ratio analysis method. The PAH pollution level of air samples (n = 42) during the collection time of blood samples was also analyzed to compare the possible correlations between the two different results.

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Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China

Cited by 32 publications

References 32 publications

Pulmonary Hypertension Complicating Pregnancy

Pulmonary Hypertension Complicating Pregnancy

Postpartum pulmonary circulation in pregnant rats with monocrotaline-induced pulmonary arterial hypertension

Polycyclic aromatic hydrocarbons residues and the carcinogenic risk assessment to pregnant women in Nantong, China using QuEChERS method and HPLC—A pilot case study

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