PURPOSE:The management of pregnant women with pulmonary hypertension is difficult, with many centers continuing to report a 50–66% mortality rate. We report our experience with 37 consecutive pregnancies and deliveries, including the initial 6 cases reported at CHEST 2003.
METHODS:Simple assembly of data for cumulative patients treated by our center or distant consultation.
RESULTS:We were involved with 37 pregnant women with pulmonary hypertension of all causes (2 sickle cell, 7 congenital heart, 4 lupus, 2 anorexic drug-related, 4 post mitral stenosis, and 18 idiopathic). The demographics included: average age 27 years, average mean pulmonary artery pressure 61mmHg, average hospital length-of-stay 5 days, 1 elective abortion at 22 weeks, 5 C-section deliveries, 36 live infants, and 37 live mothers post delivery. Medications for pulmonary arterial hypertension: digitalis, dobutamine, IV epoprostanol, IV/SQ treprostinol, diuretics, inhaled nitric oxide, and oxygen. All deliveries were completed at 36–37 weeks, with a spinal anesthetic and a multidisciplinary team.
CONCLUSION:An aggressive high-risk management team approach, early delivery, and meticulous post partum care resulted in successful outcomes in this high-risk population, with no fetal or maternal deaths.
CLINICAL IMPLICATIONS:Our method of pregnancy management has been consistently successful in this high-risk population. The pre and post delivery management will be fully reviewed.
DISCLOSURE:Dianne Zwicke, No Financial Disclosure Information; No Product/Research Disclosure Information