Primary pulmonary hypertension during pregnancy: A case report

Albackr, Hanan; Aldakhil, Lateefa O.; Ahamd, Alshaer

doi:10.1016/j.jsha.2012.12.001

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…Prevention of bleeding complications after a caesarean section is of high importance and oxytocin remains the first-line drug [38]. However, oxytocin has to be used carefully as it can cause hypotension and reflex tachycardia [38], potentially leading to an increase in pulmonary artery pressure in PAH patients [39,40]. Further management of women with PAH following delivery includes advice with regards to breastfeeding.…”

Section: Post-natal Care For the Mother And Neonatementioning

confidence: 99%

Pregnancy in pulmonary arterial hypertension

2016

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Despite advanced therapies, maternal mortality in women with pulmonary arterial hypertension (PAH) remains high in pregnancy and is especially high during the post-partum period. However, recent data indicates that morbidity and mortality during pregnancy and after birth have improved for PAH patients. The current European Society of Cardiology/European Respiratory Society guidelines recommend that women with PAH should not become pregnant. Therefore, the risks associated with pregnancy must be emphasised and counselling offered to women at the time of PAH diagnosis and to women with PAH who become pregnant. Early termination should be discussed. Women who choose to continue with their pregnancy should be treated at specialised pulmonary hypertension centres with experience in managing PAH during and after pregnancy.

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Section: Post-natal Care For the Mother And Neonatementioning

confidence: 99%

Pregnancy in pulmonary arterial hypertension

2016

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“…PAH patients are prone to hypoxemia (1), and this study found that it directly affects intraoperative bleeding. Intravenous administration of oxytocin may incr ease the burden on the heart of patients (26,27), but the bleeding volume of 76.2% of patients in this study was well-controlled by injection of oxytocin through the uterine wall. However, there is currently no study on the dose of oxytocin related to uterine wall injection, and it needs to be administered reasonably according to the uterine contraction and the patient's condition.…”

Section: Mdt Managementmentioning

confidence: 62%

Multidisciplinary Team Managements and Clinical Outcomes in Patients With Pulmonary Arterial Hypertension During the Perinatal Period

Shu

Feng

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: Pulmonary arterial hypertension (PAH) patients with pregnancy have high maternal mortality. This study aimed to provide clinical evidence with multidisciplinary team (MDT) management and to evaluate the clinical outcomes in PAH patients during the perinatal period.Methods: We conducted a retrospective evaluation of PAH patients pregnant at the First Affiliated Hospital of Chongqing Medical University between May 2015 and May 2021.Results: Twenty-two patients (24 pregnancies) were included in this study and received MDT management, and 21 pregnancies chose to continue pregnancy with cesarean section. Nine (37.5%) were first-time pregnancies at 27.78 ± 6.16 years old, and 15 (62.5%) were multiple pregnancies at 30.73 ± 3.71 years old. The average gestational week at hospitalization and delivery were 29.38 ± 8.63 weeks and 32.37 ± 7.20 weeks, individually. Twenty-one (87.5%) pregnancies received single or combined pulmonary vasodilators. The maternal survival rate of PAH patients reached 91.7%. Fifteen (62.5%) pregnancies were complicated with severe adverse events. Patients with complicated adverse events showed lower percutaneous oxygen saturation (SpO2), lower albumin, lower fibrinogen, higher pulmonary artery systolic pressure (PASP), higher blood pressure, longer activated partial thromboplastin time, and longer coagulation time. Fourteen (66.7%) pregnancies with cesarean sections were prematurely delivered and 85.7% newborns who survived after the operation remained alive.Conclusion: The survival rate of parturients with PAH was improved in relation to MDT and pulmonary vasodilator therapy during the perinatal period compared with previous studies. SpO2, albumin, PASP, blood pressure, and coagulation function should be monitored carefully in PAH patients during pregnancy.

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“…33 Most of the deaths were documented within one month after delivery predominantly due to right ventricular failure. 34,35 Inhaled NO, prostanoids and inhaled iloprost are useful to reduce the risk of postpartum right ventricular failure in these patients. Patients with RV decompensation with hypotension may also require vasopressors and inotrophic agents.…”

Section: Postnatal Care For Mother and Neonatementioning

confidence: 99%

Pulmonary hypertension in pregnancy

Durga¹,

Yuvarajan²,

Praveen³

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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Pulmonary hypertension is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest as assessed by right heart catheterisation. Pulmonary hypertension in pregnancy is known to be associated with significantly high morbidity and mortality rate which ranges between 30% and 56%. So during pregnancy, efforts to be made to diagnose common medical ailments that can be complicated by pulmonary hypertension. Bedside 2D Echo and thoracic ultrasound are the strongly recommended in these patients to diagnose early and prevent the devastating complications. Relevant blood investigations need to be sent to diagnose the underlying etiology and to assess the prognosis. Cardiac catheterization is the gold standard investigation of choice for pulmonary hypertension. But it is 1 performed in very few cardiac centres in developing countries. In India diagnosis largely depends on echocardiography. It should be made clear to women at the time of their PAH diagnosis that pregnancy is not recommended due to the high maternal and fetal risks. If a woman with known PHT become pregnant, counselling should be given for therapeutic abortion. If they are willing for therapeutic abortion, it should be done before 22 weeks of gestation. All women with PHT should be initiated on PAH specific therapies (prostanoids, ccbs, phosphodiesterase inhibitors) except endothelin receptor blockers as it is teratogenic. Pregnancy in PAH is difficult to manage and needs mutidisciplanary team. Pregnancy is not recommended in women with PAH and appropriate counselling to be done to the mother and their relatives.

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Primary pulmonary hypertension during pregnancy: A case report

Cited by 5 publications

References 10 publications

Pregnancy in pulmonary arterial hypertension

Pregnancy in pulmonary arterial hypertension

Multidisciplinary Team Managements and Clinical Outcomes in Patients With Pulmonary Arterial Hypertension During the Perinatal Period

Pulmonary hypertension in pregnancy

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