Maternal mortality is a known complication of pregnancy in PAH patients. Most maternal deaths occur during the immediate postpartum period. We present the successful clinical management of six pregnant women, including the delivery of six viable infants.
Six women were referred to the pulmonary hypertension clinic for management of moderate to severe PAH during their pregnancies. The underlying disease states included 1 with SLE/anticardiolipin antibody syndrome, 2 with PPH, 2 with PAH after corrected congenital heart disease, and 1 with stenosis of a bioprosthetic mitral valve with persistent PAH. Clinic visits occurred monthly until 28 weeks gestation, at which time weekly visits with echocardiographic imaging of the right heart was completed. The delivery date was dictated by any deterioration in right ventricular function. All physicans participating in the delivery were included in a pre-delivery planning meeting.
The average age of the women was 25.1 (range 22–34) years. The average gestational time at delivery was 35 weeks (range 33 weeks + 3 days - 36 weeks + 4 days). Four deliveries were scheduled with epidural anesthesia, while 2 had scheduled C-sections with general anesthesia. Epoprostanol, nitric oxide, and dobutamine were utilized in their management. The average length of the hospital stay for the mothers was 5 days, while the average stay for the infants was 8 days. Three of the mothers developed right heart failure symptoms prior to delivery, but all six proceeded through the deliveries safely and successfully.CONCLUSIONS: Six consecutive pregnant women with PAH were successfully managed and delivered without adverse outcome to the mother or the baby. Weekly surveillance of right ventricular function beginning at week 28 was critical in scheduling the timing of delivery. We attributed the successful management and survival to this close monitoring and induction of delivery before term.
Although pregnancy with PAH is extremely high risk, appropriate clinical and hemodynamic management, with close attention to right ventricular function can result in a successful outcome.
D.L. Zwicke, None.