Pulmonary hypertension and pregnancy: The experience of a tertiary institution over 15 years.
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Date
2015-04
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Abstract
Background: Pulmonary hypertension (PH) in pregnancy is associated with a high maternal mortality and
morbidity and has been found to be as high as 30-56%. Aim: To review the management of such patients
in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small
case series and 2 meta-analyses. Materials and Methods: A review of all patients admitted to our institution
for management of PH in pregnancy between 1994 and February 2009 was undertaken. Cases were
identified from the high-risk pregnancy database within the department of anesthesia and from the hospital
medical records. Severity of PH, type of PH, NYHA functional status at presentation and delivery, mode of
delivery, peripartum monitoring and APGAR scores were noted. Patients were reviewed by a multidisciplinary
team and management planned accordingly. Results: 19 eligible patients were identified. Patients who
were significantly sick due to their PH were aggressively managed during pregnancy. Overall there was an
improvement in NYHA functional status at the time of delivery. Epidural analgesia and anesthesia for labor
and operatively delivery seem to be the ideal choice. Conclusion: Multidisciplinary approach is a key to
the successful management of these patients. Secondary PH results in higher morbidity and mortality, in
particular, older the age higher the maternal morbidity and mortality.
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Keywords
Anesthesia, pregnancy, pulmonary hypertension
Citation
Monagle John, Manikappa Shashikanth, Ingram Brendan, Malkoutzis Vangy. Pulmonary hypertension and pregnancy: The experience of a tertiary institution over 15 years. Annals of Cardiac Anaesthesia. 2015 Apr; 18(2): 153-160.