Outcome of pregnancies in women with pulmonary hypertension: a single‐centre experience from South India

Abstract

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.

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

“…However, recent cohort studies have challenged this recommendation, particularly for those women who are receiving targeted medications for PH. 11–13 In a European registry of 151 pregnant women with PH, the authors found that mortality in this group of patients with various forms of PH was lower than previously reported, with a maternal mortality rate of 3.3% within one week after delivery. 12 The authors attributed this lower than expected maternal mortality risk to specialized treatment of PH during pregnancy and delivery.…”

“…11 In a recent report from India, which included 81 pregnancies in 73 women with PH and 80.8% PH caused by CHD, maternal mortality occurred in 5.4% patients, which was significantly lower than expected. 13 The authors concluded that intensive multidisciplinary team management and active administration of novel targeted medications for PH significantly improved maternal outcomes, even in low- to middle-income countries with limited resources. 13 Although these results shed some lights on the potential improvements of the prognosis for pregnant women with PH, there are some studies that have reported unaffected high maternal and neonatal mortality even with contemporary PH management.…”

“…13 The authors concluded that intensive multidisciplinary team management and active administration of novel targeted medications for PH significantly improved maternal outcomes, even in low- to middle-income countries with limited resources. 13 Although these results shed some lights on the potential improvements of the prognosis for pregnant women with PH, there are some studies that have reported unaffected high maternal and neonatal mortality even with contemporary PH management. A retrospective study in the US including 49 cases of pregnant women with PH showed a 16% in-hospital maternal mortality rate, 16 which was consistent with a 25% in-hospital incidence of adverse cardiovascular events reported from another US study based on the national inpatient samples of PH women.…”

“…Early studies consistently showed that the mortality risk was dramatically higher for women with PH who became pregnant; however, some recent studies suggest that the pregnancy outcomes have improved, particularly for those with moderate PH treated with targeted PH medications. 11–13 These findings highlight the possibility that pregnancy may not necessarily be contraindicated for women with moderate PH. Due to the limited cases of pregnant women with PH, long-term outcomes have been rarely reported.…”

A study to evaluate pregnancy with maternal heart disease: a prospective observational study at a tertiary care centre in India

“…9,18,19 Poor NYHA class or cyanosis was reported to be a predictive factor for perinatal mortality and morbidity. 20,21 Maternal morbidity was significantly higher in our highrisk group. This finding supports previous studies, which have shown that cardiovascular maternal morbidity correlates with the maternal functional status.…”