Pulmonary Hypertension in Pregnancy

Pulmonary hypertension (PH) describes a syndrome characterized by progressive exertional dyspnea, signs of right heart failure, and echocardiographic findings of right ventricular dysfunction caused by a host of cardiopulmonary diseases. This chapter presents a systemic approach to the pregnant patient with suspected PH and provides a diagnostic and management strategy. Pulmonary vascular disease observed during pregnancy is associated with progressive exertional dyspnea, fatigue, lack of energy, dizziness, syncope, and substernal chest pain. In addition to right heart catheterization, the diagnosis of chronic thromboembolic pulmonary hypertension also requires radiographic chest imaging to evaluate for presence of pulmonary vascular filling defects. Discharge and follow-up with the obstetrical team and pulmonary arterial hypertension (PAH) specialist are vital to assess maternal clinical status and adjust PAH medications to optimize maternal functional status. Accurate diagnosis of PAH in a patient with suspected or echo-determined PH requires confirmation by right heart catheterization.