Pulmonary hypertension during pregnancy: management of two cases

Abstract

Pregnancy is contraindicated in case of pulmonary hypertension, a highly morbid disease affecting young women of childbearing age. Therefore, in such cases, a multidisciplinary approach is indispensable to plan optimal treatment for patients who wish to pursue a pregnancy even though their heart disease exposes them to a high level of risk.

Epoprostenol treatment for idiopathic pulmonary arterial hypertension in pregnancy

“…Postoperative increases in peripheral vascular resistance occur and may contribute to post-partum mortality. 21 Although there may be less alteration to hemodynamic parameters with regional anesthesia, good outcomes have been reported with both regional and general anesthesia [1][2][3][4][22][23][24] Little has been written about the effects of epoprostenol on the intrauterine environment. In our case, intensive fetal surveillance during intravenous epoprostenol therapy failed to show fetal harm.…”

Spinal Anesthesia for Cesarean Delivery of a Pulmonary Arterial Hypertension Parturient; A Case Report

“…In such cases both general and regional anesthesia have been performed successfully (5). The main goal of anesthesia management in this group of patients is avoiding desaturation and improving oxygenation.…”

“…Pulmonary arterial hypertension is associated with a significant risk of maternal mortality during pregnancy and delivery and it is associated with significant risk of maternal death. In this situation, cardiac function depression leads to increased pulmonary vascular resistance (5).…”

Cesarean Delivery in Severe Pulmonary Hypertension: A Case Report

“…Initial symptoms are often nonspecific, and PH is only diagnosed in late pregnancy or as a casual finding during transthoracic echocardiography (TTE) (1,2). In the presence of PH, a physiological increase in blood volume that occurs during pregnancy causes volume overload in the right heart and problems of hemodynamic compensation that may have serious consequences, such as thromboembolic events, cerebrovascular accidents, or blood hyperviscosity syndrome (7). Anesthetic management of a parturient with PH undergoing cesarean section is a challenge as maternal mortality rate remains 30%-50% irrespective of adequate medical care (1,(8)(9)(10).…”