Pregnancy and pulmonary hypertension

Abstract

Pregnancy is usually contraindicated in patients with pulmonary hypertension (PH). Risk factors associated with the outcome of this rare disease have not been specifically explored before.Medical records were retrospectively reviewed to identify patients with coexisting PH and pregnancy or delivery at Peking Union Medical College Hospital between January 2009 and June 2018. Demographics, characteristics of PH and pregnancy, management and outcomes were analyzed.Thirty-six pregnant women with PH were identified, including 30 cases in WHO group 1, 5 cases of group 2 and 1 case of group 4. Median pregnancy duration was 24 weeks. The overall maternal mortality rate was 8.3% (3/36), and the late fetal mortality was 31.6% (6/19). Pulmonary vascular-targeted medications were used in 17 of 26 patients with moderate or severe PH, but in none with mild PH. Maternal mortality was 2/15, 1/11, and 0 among women with severe, moderate, and mild PH, respectively. All deaths reported to be diagnosed of PH after pregnancy, and have New York Heart Association (NYHA) grades II to IV. Cesarean section was performed in 22 patients, and mortality was 3/16 among women receiving cesarean section with general anesthesia.Maternal mortality is associated with PH classification, severity of PH, delayed diagnosis of PH, and NYHA classification. Regional anesthesia seems superior to general anesthesia for cesarean section.

Pregnancies in women with pulmonary hypertension remain challengeable: a single-center experience from East China

“…The overall maternal mortality in the whole cohort was 2.8%, which was lower than that reported previously [5][6] [7] . In our study, the congenital heart disease (65.4%) is the leading cause of PH, followed by left heart disease (29.8%), idiopathic cause (2.5%) and connective tissue disease (2.3%), with a mortality rate of 1.1%, 3.4%, 6.3% and 35.3%, respectively.…”

“…In the previous study, PH classification, severity of PH, timing of diagnosis, and NYHA classification were reported to have association with a high maternal mortality in PH women [7] . In our study, we explore the relation between all these factors and mortality, and the results also indicate their adverse effect on maternal mortality in the univariate analysis, while only low oxygen saturation will contribute to a high mortality in the final logistic regression model.…”

Maternal and fetal outcomes in pregnant women with pulmonary hypertension: The impact of left heart disease

“…The natural history of cardiomyopathy can be worsened by the hemodynamic changes in pregnancy [ 23 ], and likely contributed to the death of at least 1 of the women, who had multiple heart failure hospitalizations post-partum. Finally, we may have identified more deaths in Group 2 PH due to longer follow up than prior reports [ 9 , 18 , 20 , 24 ]. Given that pregnancy alters long term cardiovascular risk [ 25 ], and the majority of deaths within 1 year of pregnancy are related to cardiovascular disease [ 5 ], extended follow-up in PH patients may be warranted to evaluate late post-partum mortality.…”

“…Pregnancy related outcomes for women with Group 2 PH are not well described [ 19 ], as much of the previous literature has focused on women with Group 1 PH [ 4 , 8 , 9 ]. Prior studies that included Group 2 PH were comprised of a high prevalence of valvular heart disease leading to PH, and reported lower mortality than Group 1 PH [ 9 , 18 , 20 ]. In comparison, our study reports late mortality in Group 2 PH, and though sample size is limited (n = 12), 100% 1-year survival in women with Group 1 PH.…”

Cesarean Section in a Group 1 Pulmonary Hypertension Parturient Patient: A Case Report

“…The mode of delivery significantly influences both maternal and fetal outcomes. Cesarean section is often the preferred mode of delivery for patients with PH because it can mitigate several hemodynamic risks associated with vaginal delivery [ 10 , 11 ]. First of all, the pain experienced during labor can activate the sympathetic nervous system, leading to tachycardia and an increase in both systemic and pulmonary vascular tone [ 10 ].…”