Pulmonary hypertension in pregnancy: treatment with pulmonary vasodilators

Abstract

Early diagnosis of pulmonary hypertension is critical. Volume overload postpartum might significantly contribute to decompensation. We recommend a year of successful therapy after a response to vasodilator therapy and near-normal right ventricular function before pregnancy is considered. In complicated pregnancies, women must balance the best estimate of risk with the value they put on pregnancy.

Epoprostenol treatment for idiopathic pulmonary arterial hypertension in pregnancy

“…15 Current published experience with prostanoids in pregnancy is limited. 4,5,15,17,18 Early initiation of treatment before acute decompensation decreases mortality and improves the outcomes. 15 In non-pregnant patients a significant survival advantage is seen with long-term intravenous epoprostenol, which seems to justify the cost.…”

Síndrome De Eisenmenger Y Embarazo

“…Sin embargo, dada la incorporación de nuevas modalidades de tratamiento para la hipertensión pulmonar, tales como prostaciclinas, heparinas, oxido nítrico, L-arginina y sildenafil, la mortalidad materna se redujo en 30%, siendo las principales causas el ingreso tardío a control obstétrico y diagnóstico de hipertensión pulmonar después de las 25 semanas de gestación (4). Prostaciclina (PGI2) en infusión o en aerosol y la inhalación de óxido nítrico se han descrito como tratamientos efectivos de la hipertensión pulmonar (13,14), y han sido utilizados con éxito en la gestación asociada a hipertensión pulmonar primaria (14)(15)(16)(17)(18)(19). Más recientemente, ha aparecido las primeras comunicaciones sobre casos aislados, beneficiados por una intervención dirigida a aumentar la disponibilidad de guanosina monofosfato cíclica (cGMP), el mensajero intracelular de NO, mediante el inhibidor de fosfodiesterasa sildenafil (20)(21)(22)(23)(24); este ha sido empleado como droga única (22,23) o en asociación a NO inhalado (24).…”

Use of inhaled nitric oxide for emergency Cesarean section in a woman with unexpected primary pulmonary hypertension

“…1,2 A maternal mortality rate of up to 50% and sudden irreversible deterioration in the postpartum period has been reported. 3 Cesarean section (CS) in a pregnant woman with PPH presents an enormous challenge for the anesthesiologist. 4 Impaired pulmonary vascular endothelial nitric oxide production plays a role in the pathogenesis of PPH.…”

“…Thus, an increase in preload, as seen during pregnancy (increase in blood volume and cardiac output) can easily result in right ventricular failure. [3][4][5][6][7][8] PPH indirectly alters left ventricular function due to a decrease in left ventricular preload and ventricular interdependence (via septal wall motion of the overloaded right ventricle). 9 Decrease in pulmonary hypertension lowers right ventricular afterload, improves right ventricular ejection fraction, decreases right ventricular work and size and improves both diastolic and systolic left ventricular function.…”

“…[6][7][8][9] The response of pulmonary arteries to vasodilation is important in the outcome of PPH in pregnant women. 3 iNO is a potent selective pulmonary vasodilator. 5 Only a few reports on the use of iNO during delivery in patients with Eisenmenger's syndrome have been published.…”