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Original Research: Pulmonary Vascular Diseases |

Management of Pulmonary Arterial Hypertension During PregnancyPulmonary Arterial Hypertension and Pregnancy: A Retrospective, Multicenter Experience

Alexander G. Duarte, MD, FCCP; Shibu Thomas, MD; Zeenat Safdar, MD, FCCP; Fernando Torres, MD; Luis D. Pacheco, MD; Jeremy Feldman, MD, FCCP; Bennet deBoisblanc, MD, FCCP
Author and Funding Information

From the Division of Pulmonary/Critical Care Medicine (Drs Duarte and Thomas), The University of Texas Medical Branch at Galveston, Galveston, TX; Pulmonary/Critical Care Medicine (Dr Safdar), Baylor College of Medicine, Houston, TX; Pulmonary/Critical Care Medicine (Dr Torres), The University of Texas Southwestern Medical Center, Dallas, TX; Department of Obstetrics and Gynecology and Department of Anesthesiology (Dr Pacheco), The University of Texas Medical Branch at Galveston, Galveston, TX; Arizona Pulmonary Specialists Ltd (Dr Feldman), Phoenix, AZ; and Pulmonary and Critical Care Medicine (Dr deBoisblanc), LSU Health New Orleans, New Orleans, LA.

Correspondence to: Alexander G. Duarte, MD, FCCP, Pulmonary/Critical Care Medicine, The University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX 77555-0561; e-mail: aduarte@utmb.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This work was supported by The University of Texas Medical Branch at Galveston-Internal Medicine Departmental fund.


Chest. 2013;143(5):1330-1336. doi:10.1378/chest.12-0528
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Background:  Pulmonary arterial hypertension (PAH) is a rare disease with a predilection for young women that is associated with right ventricular failure and premature death. PAH can complicate pregnancy with hemodynamic instability or sudden death during parturition and postpartum. Our aim was to examine the impact of PAH on pregnancy outcomes in the modern era.

Methods:  We conducted a retrospective evaluation of pregnant patients with PAH managed between 1999 and 2009 at five US medical centers. Patient demographics, medical therapies, hemodynamic measurements, manner of delivery, anesthetic administration, and outcomes were assessed.

Results:  Among 18 patients with PAH, 12 continued pregnancy and six underwent pregnancy termination. Right ventricular systolic pressure in patients managed to parturition was 82 ± 5 mm Hg and in patients with pregnancy termination was 90 ± 16 mm Hg. Six patients underwent pregnancy termination at mean gestational age of 13 ± 1.0 weeks with no maternal deaths or complications. Twelve patients elected to continue their pregnancy and were hospitalized at 29 ± 1.4 weeks. PAH-specific therapy was administered to nine (75%) at time of delivery consisting of sildenafil, IV prostanoids, or combination therapy. All parturients underwent Cesarean section at 34 weeks with one in-hospital death and one additional death 2 months postpartum for maternal mortality of 16.7%.

Conclusions:  Compared with earlier reports, maternal morbidity and mortality among pregnant women with PAH was reduced, yet maternal complications remain significant and patients should continue to be counseled to avoid pregnancy.


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