Pulmonary hypertension in pregnancy

Pulmonary hypertension describes a clinical condition caused by different cardiopulmonary diseases. Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are progressive conditions characterized by right ventricular failure and increased pulmonary artery pressures that are clinically challenging to manage in the pregnant patient. This chapter reviews diagnosis and management of the pregnant patient with PAH or CTEPH. Initial recognition of pulmonary hypertension frequently occurs with use of transthoracic echocardiography. Transthoracic echocardiography is an easily accessible, noninvasive screening test for pulmonary hypertension. Calcium channel antagonists and PAH-specific therapies have been reported to improve exercise capacity, reduce symptoms, and improve survival in non-pregnant patients with PAH. CTEPH is a disease state that develops as a result of recurrent pulmonary emboli that occlude the pulmonary vasculature, leading to pulmonary hypertension. Management of CTEPH is based on anticoagulation treatment with warfarin. However, in the pregnant patient, warfarin should be discontinued due to the teratogenic effects on the fetus.