Objective To study maternal complications and pregnancy outcome in women with pulmonary hypertension, attending a tertiary centre in south India.Study design Retrospective observational study.Setting Tertiary centre in south India.Population Pregnant women with pulmonary hypertension.Method Data regarding demographics, clinical course, medication received, and echocardiographic diagnosis regarding pulmonary hypertension and antenatal care received were collected from the records. Details of labour and delivery, and postpartum follow up were retrieved. We compared the outcome based on the presence or absence of cyanosis and right ventricular systolic pressure levels.Main outcome measures Maternal mortality, occurrence of complications such as heart failure, fetal growth restriction.Results There were 81 pregnancies in 73 women with pulmonary hypertension. The majority of them had pulmonary hypertension secondary to congenital heart disease (80.8%); 17.8% had Eisenmenger syndrome. An advanced pulmonary artery hypertension (PAH) medication, sildenafil, was administered in 25 (31.3%) pregnancies. There were four maternal deaths, of which three had Eisenmenger syndrome. Heart failure complicated 6.3% and fetal growth restriction 26.3% of pregnancies. Morbidity was significantly increased in women with pulmonary hypertension associated with a cyanotic cardiac lesion or with right ventricular systolic pressure >70 mmHg.Conclusion Despite advances in care, mortality in pregnant women with pulmonary hypertension is a matter of concern, especially in those with Eisenmenger syndrome. Multidisciplinary team management in tertiary centres and the use of advanced PAH medications even in low-to middle-income countries with limited resources, could lead to a reduction in morbidity and mortality related to pulmonary hypertension.Keywords Eisenmenger syndrome, pregnancy, pulmonary hypertension.Tweetable abstract Multidisciplinary care and use of new medication may improve outcomes in pregnant women with pulmonary hypertension.Please cite this paper as: Keepanasseril A, Pillai AA, Yavanasuriya J, Raj A, Satheesh S, Kundra P. Outcome of pregnancies in women with pulmonary hypertension: a single-centre experience from South India. BJOG 2019; 126 (S4): 43-49.

Uterine compression sutures are commonly used for controlling postpartum hemorrhage (PPH) when standard medical treatment with uterotonic agents is unsuccessful. These sutures are safe and effective in managing PPH in the setting of uterine atony. 1,2 The first uterine compression suture was described by B-Lynch and is widely used. 3 Other commonly used uterine compression sutures include Cho's square suture and Hayman's suture. 4,5 Placing these sutures is relatively simple and prevents hysterectomy in most of the women who receive these compression sutures.Obstetrical outcome in subsequent pregnancies in these women has not been sufficiently studied. Although data from several small studies are reassuring, 6-9 some studies have reported complications like uterine rupture and placenta accreta in subsequent pregnancies. 10,11 Most of these studies are from developed countries. Very few studies from developing countries have reported the subsequent obstetrical outcome in these women. 12 In this study, the subsequent obstetrical outcome in women who received uterine compression suture at a single center in India was assessed.

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Background Women with an uncorrected single ventricle heart are at increased risk of adverse maternal and perinatal outcomes. Methods We report our experience of managing pregnant women with uncorrected single ventricles, during the time period 2011 to 2017, in a low-resource setting and compare pregnancy outcome with healthy concurrent controls. Outcomes assessed include the mode of delivery, maternal complications, neonatal death and birth weight. Results There were six pregnant women with uncorrected single ventricles who had a total of 14 pregnancies. There was one maternal death in a woman with atrioventricular-septal defect and Eisenmenger syndrome. Caesarean section rates and preterm delivery were similar, whereas perinatal loss and low-birth weight rates were higher among women with a single ventricle compared to healthy controls. Conclusion Unplanned pregnancies without prenatal counselling/care pose a challenge to physicians especially in low to middle income countries and with the high risk of morbidity/mortality, pregnancy should be discouraged.

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