04 February 2019 by Shine Kumar

Outcomes of pregnancy associated with pulmonary arterial hypertension

Background:

Pregnancy associated with Pulmonary Arterial Hypertension (PAH) poses significant maternal and fetal mortality and morbidity risks. With recent advances in management of PAH outcomes may be better.

Aim

To describe maternal and fetal outcomes in pregnancy associated with PAH from a low resource environment.
Materials and methods
We analysed prospectively collected data of maternal and fetal outcomes of pregnancy associated with PAH (2008 - 2018).

Results

We identified 27 pregnancies for 17 patients (mean age 27 ± 4.3 years, mean weight 51.18 ± 8.1 kg, mean body surface area 1.37 ± 0.14 m2). Diagnosis were Eisenmenger syndrome – 13 (76%), idiopathic pulmonary arterial hypertension (IPAH) – 2 (12%) and one case each of residual PAH after atrial septal defect closure and systemic lupus erythematosus (SLE) (6%). All except one were on phosphodiesterase 5 inhibitors during pregnancy. There were no cardiac complications prenatally. Among 27 pregnancies, 18 (66.6%) culminated in live births for 12 patients. There were 10 (55.5%) emergency caesarian section (CS) (indication - three worsening PAH, seven fetal distress), three (16.7%) elective CS and five (27.8%) normal deliveries. Among CS patients, type of anesthesia was epidural in 11(84.6%) and general in rest. The average gestational age was 34.5 ± 3 weeks with six (33.3%) term delivery. There was one neonatal death due to extreme prematurity, two still births and three medical termination of pregnancy and spontaneous abortions each. Among 12 patients with successful pregnancy, six (50%) had right ventricular dysfunction and required inotropic support postnatally. The mean hospital stay post delivery was 12.9 ± 4.7 days which included mean Intensive Care Unit stay of 5.1 ± 2.3 days. There was one maternal mortality (6%).

Conclusion

Pregnancy outcomes have improved in patients with PAH. Appropriate case selection, rigorous follow up and multidisciplinary care delivery can minimise complications

 

Key Contributors

1 Shine Kumar, 2 Cini ,3Sudha, 4Radhamony, 5 Krishna Kumar 1 Associate Professor, Dept. of Pediatric Cardiology, 2 Assistant Professor, Dept. of Obstetrics and Gynecology, 3 Professor, Dept of Obstetrics and Gynecology ,4 Professor and Head, Dept. of Obstetrics and Gynecology, 5 Professor and Head, Dept of Pediatric Cardiology, AIMS, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India


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