Cesarean Delivery in Severe Pulmonary Hypertension: A Case Report

Abstract

Pregnancy in a woman with pulmonary hypertension carries a prohibitively high risk of maternal mortality, and pregnancy is contraindicated in such patients. Some women decide to continue with their pregnancy despite being aware of possible fatal maternal outcome. The management of pulmonary hypertension in pregnancy is a challenge and requires a multiprofessional approach. We report the case of a patient with severe pulmonary hypertension, who successfully underwent elective cesarean section under epidural anesthesia at 38 weeks of gestation and discuss major issues associated with the obstetric and anesthetic management of pregnant patients with pulmonary hypertension.

Clinical characteristics and pregnancy outcomes in parturients with pulmonary hypertension: experience with 39 consecutive cases from China

“…Perniciously, vagina delivery might induce high risk of right ventricular pressure due to pushing, so it should be avoided in these patients. For anesthetic method of cesarean section, it should be chosen according to the NYHA class of patients as following: neuraxial anesthesia for NYHA class I-II and general anesthesia for NYHA class III-IV, since anesthetic agents could induce less vasodilation and cardiac depression [22][23][24]. Therefore, the present authors also followed this principle in this study in order to maintain the normal vasodilation.…”