Pregnancy and pulmonary hypertension

Abstract

Pulmonary hypertension during pregnancy is associated with considerable risks of maternal mortality and morbidity. Our systematic review of the literature on the use of targeted treatments for pulmonary arterial hypertension during pregnancy indicates a considerable decrease of mortality since a previous review in 1998 (16% v 38%), and a further non-significant decrease in mortality since the latest review in 2009 (16% v 25%). In addition to the use of targeted treatments, the timely institution of these treatments, and early planned delivery, may contribute to better outcome. Furthermore, research suggests that women with mild pulmonary hypertension or favourable functional class may have a better prognosis, but there is yet no proof of decreased mortality among these women. Despite an improved prognosis, pregnancy is contra-indicated in women with pulmonary hypertension and, when pregnancy occurs, termination should be considered. When pregnancy continues, management by a multidisciplinary team in a specialist centre is indicated.

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…192,193 In patients with CHD, pulmonary arterial hypertension (PAH) most commonly occurs as a result of long-term left-to-right shunting, leading to increased pulmonary flow that eventually causes high PVR, resulting in reversed or bidirectional shunts, which is referred to as Eisenmenger syndrome. It should be noted, however, that PAH may also develop in patients who have undergone surgical or transcatheter repair of their defects.…”

“…4 The greatest risk of death is in the postpartum period but may extend beyond 6 weeks after delivery. 4,164,193 The hemodynamic factors occurring in pregnancy that contribute to poor clinical outcomes in PAH include the following:…”

“…Fetal loss is equally high, with rates of spontaneous abortion of 40% to 50%. 164,[193][194][195][196][197] The fetus is typically exposed to a hypoxic environment and is at risk for intrauterine growth restriction and preterm delivery.…”

“…5,199 Hospital admission for bed rest and monitoring is usually recommended by the third trimester. 5,68,193,195 Cardiac monitoring, pulse oximetry, peripheral vein access for fluids with bubble filters to avoid the risk of air emboli, and compression stockings to avoid venous stasis should be standard care for all in-patients. Oxygen therapy is indicated in the event of arterial desaturation or maternal decompensation.…”

Determination, knowledge and prevalence of pregnancy-induced hypertension/eclampsia among women of childbearing age at Same District Hospital in Tanzania

“…Mild Severe preeclampsia is at the other end of the spectrum and is characterized by significant hypertension, more pronounced proteinuria (>5.0 g/d), and evidence of endorgan damage due to systemic vasoconstriction. Severe preeclampsia can later lead to eclampsia which is the most dangerous condition to maternal and fetal wellbeing (Pieper et al, 2014).…”