Contemporary approach to pulmonary arterial hypertension in pregnancy
Zwicke DL. Contemporary approach to pulmonary arterial hypertension in pregnancy. Presented at Pulmonary Hypertension Association’s 2016 International PH Conference and Scientific Sessions. 2016:121.
Presented at Pulmonary Hypertension Association’s 2016 International PH Conference and Scientific Sessions.
Purpose: The purpose of our study is to show that women with pulmonary arterial hypertension (PAH) when treated for PAH can have successful outcomes with their high risk pregnancies.
Background: The management of pregnant women with pulmonary arterial hypertension is difficult, with many centers continuing to report high mortality rates (>50%). We report our experience with 128 consecutive pregnancies between 2000 and 2015, with 100% maternal survival.
Methods: Simple assembly of data for 128 consecutive patients treated at our center or distant consultation (27-US states and 17 other countries). Results: We were involved with 128 pregnant women who birthed 128 live babies. The etiology of the PAH included all causes. The average maternal age was 27 years, average mean pulmonary artery pressure was 47mmHg, average length of hospital stay was 5 days, 1 elective termination at 22 weeks, 17 Cesarean sections and 111 vaginal deliveries, with 128 live babies including one set of twins. Seven women have had multiple pregnancies while on PAH treatment. Medications included all PAH therapies available in the US, excluding the ERA group. All deliveries were completed between 29 and 36.5 weeks of gestation. Two patients had general anesthesia and 126 had epidural anesthesia.
Conclusions: An aggressive, high risk team approach, early deliver, and meticulous post-partum fluid management resulted in successful outcomes in this high risk population, with no fetal or maternal deaths.