Management of pulmonary arterial hypertension during pregnancy: A retrospective, multicenter experience

Alexander Duarte, Shibu Thomas, Zeenat Safdar, Fernando Torres, Luis Pacheco, Jeremy Feldman, Bennet DeBoisblanc

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1330-1336
Number of pages7
JournalChest
Volume143
Issue number5
DOIs
StatePublished - May 2013

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Pulmonary Hypertension
Pregnancy
Maternal Mortality
Parturition
Postpartum Period
Hemodynamics
Maternal Death
Premature Mortality
Ventricular Pressure
Pregnancy Outcome
Rare Diseases
Sudden Death
Cesarean Section
Gestational Age
Prostaglandins
Anesthetics
Pregnant Women
Therapeutics
Mothers
Demography

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Management of pulmonary arterial hypertension during pregnancy : A retrospective, multicenter experience. / Duarte, Alexander; Thomas, Shibu; Safdar, Zeenat; Torres, Fernando; Pacheco, Luis; Feldman, Jeremy; DeBoisblanc, Bennet.

In: Chest, Vol. 143, No. 5, 05.2013, p. 1330-1336.

Research output: Contribution to journalArticle

Duarte, Alexander ; Thomas, Shibu ; Safdar, Zeenat ; Torres, Fernando ; Pacheco, Luis ; Feldman, Jeremy ; DeBoisblanc, Bennet. / Management of pulmonary arterial hypertension during pregnancy : A retrospective, multicenter experience. In: Chest. 2013 ; Vol. 143, No. 5. pp. 1330-1336.
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