Pulmonary Hypertension in Pregnancy

Banerjee, Debasree; Ventetuolo, Corey E.

doi:10.1055/s-0037-1602242

Cited by 15 publications

(14 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Vaginal delivery will cause pain and increase intrathoracic pressures which may help to decrease venous return. [ 3 ] Therefore, cesarean delivery between 34 and 36 weeks gestation is recommended as the preferred mode of delivery for pregnant women with PH by the Pulmonary Vascular Research Institute. [ 18 ] In our study, because all deliveries were premature, vaginal delivery was used in only patients with aborted fetus, and all patients with gestational age of more than 24 weeks received cesarean section.…”

Section: Discussionmentioning

confidence: 99%

“…Pregnancy causes hemodynamic, anatomic, and biochemical changes throughout the gestation, during delivery, and in the postpartum period, which can be intolerable for a woman with PH. [ 3 ] Therefore, pregnancy in PH is contraindicated in practice guidelines due to high maternal and fetal morbidity and mortality. [ 2 ] Pregnancy can be complicated by PH because PH may be unknown before pregnancy; pregnancy may be unplanned, or some PH patients take the risk of pregnancy for social reasons.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pregnancy and pulmonary hypertension

Sun¹,

Feng

Shi³

2018

Medicine

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy and pulmonary hypertension

Sun¹,

Feng

Shi³

2018

Medicine

View full text Add to dashboard Cite

show abstract

“…Human Studies-While progesterone has known effects on the respiratory system, its impact on the cardiovascular system is less well understood (20,77). Two studies (described above) measured progesterone levels in PAH patients (19,471).…”

Section: Progesterone In the Pulmonary Vasculature And Rvmentioning

confidence: 99%

Sex, Gender, and Sex Hormones in Pulmonary Hypertension and Right Ventricular Failure

Hester

Ventetuolo

Lahm

2019

Comprehensive Physiology

Self Cite

102

View full text Add to dashboard Cite

Pulmonary hypertension (PH) encompasses a syndrome of diseases that are characterized by elevated pulmonary artery pressure and pulmonary vascular remodeling and that frequently lead to right ventricular (RV) failure and death. Several types of PH exhibit sexually dimorphic features in disease penetrance, presentation, and progression. Most sexually dimorphic features in PH have been described in pulmonary arterial hypertension (PAH), a devastating and progressive pulmonary vasculopathy with a 3-year survival rate <60%. While patient registries show that women are more susceptible to development of PAH, female PAH patients display better RV function and increased survival compared to their male counterparts, a phenomenon referred to as the "estrogen paradox" or "estrogen puzzle" of PAH. Recent advances in the field have demonstrated that multiple sex hormones, receptors, and metabolites play a role in the estrogen puzzle and that the effects of hormone signaling may be time and compartment specific. While the underlying physiological mechanisms are complex, unraveling the estrogen puzzle may reveal novel therapeutic strategies to treat and reverse the effects of PAH/PH. In this article, we (i) review PH classification and pathophysiology; (ii) discuss sex/gender differences observed in patients and animal models; (iii) review sex hormone synthesis and metabolism; (iv) review in detail the scientific literature of sex hormone signaling in PAH/PH, particularly estrogen-, testosterone-, progesterone-, and dehydroepiandrosterone (DHEA)-mediated effects in the pulmonary vasculature and RV; (v) discuss hormone-independent variables contributing to sexually dimorphic disease presentation; and (vi) identify knowledge gaps and pathways forward.

show abstract

“…1 Pregnancy is associated with significant hemodynamic changes, which may deteriorate cardiac function in women who have potential cardiac disorders. 3,4 For women with PH, deterioration of cardiac function resulting from hemodynamic changes is dramatic following delivery. 3,4 These women are likely to suffer from acute pulmonary and cardiac failure with the progression of pregnancy, which can result in both maternal and fetal mortality.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 For women with PH, deterioration of cardiac function resulting from hemodynamic changes is dramatic following delivery. 3,4 These women are likely to suffer from acute pulmonary and cardiac failure with the progression of pregnancy, which can result in both maternal and fetal mortality. Indeed, the mortality rate in pregnant women with PH was reported to be as high as 60%.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography: a retrospective cohort study in a single center from China

2021

View full text Add to dashboard Cite

Recent studies suggest that pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension. We aimed to evaluate the long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography in our clinical department. Pregnant women with pulmonary hypertension, diagnosed by a pulmonary systolic arterial pressure > 30 mmHg via echocardiography, who were admitted in our department for termination of pregnancy or delivery between 2004 and 2016 were included in this retrospective cohort study. Demographic characteristics, clinical histories, perinatal outcomes, and follow-up outcomes after discharge were reported. The primary outcome was survival of the pregnant women after discharge. A total of 88 pregnant women with pulmonary hypertension were included in this cohort study. The women were categorized into severe and moderate pulmonary hypertension groups according to their pulmonary systolic arterial pressure at admission. Women with severe pulmonary hypertension were significantly more likely to have deteriorated cardiac function and higher incidence of neonatal complications during the perinatal periods (p < 0.05). During a median follow-up of 26 months, the mortality rate was significantly higher in women with severe pulmonary hypertension (p < 0.05). However, the accumulated survival rate was >90% for women with moderate pulmonary hypertension within the follow-up period. Multivariate Cox regression analyses showed that poor cardiac function before pregnancy, irregular antenatal care, and hyperuricemia were independent mortality risk factors for women with pulmonary hypertension after discharge. In conclusion, the long-term survival of pregnant women with moderate pulmonary hypertension diagnosed by echocardiography was considered acceptable in this cohort. Our findings suggest that pregnancy might not be absolutely contraindicated in women with moderate pulmonary hypertension.

show abstract

Pulmonary Hypertension in Pregnancy

Cited by 15 publications

References 78 publications

Pregnancy and pulmonary hypertension

Pregnancy and pulmonary hypertension

Sex, Gender, and Sex Hormones in Pulmonary Hypertension and Right Ventricular Failure

Long‐term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography: a retrospective cohort study in a single center from China

Contact Info

Product

Resources

About