Title:Management of Pulmonary Hypertension during Pregnancy
Volume: 20
Issue: 3
Author(s): Yuri Matusov*, Adnan Khan, Candace Levian, John Ozimek and Victor F. Tapson
Affiliation:
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles,
CA90048, USA
Keywords:
Pregnancy, maternal mortality in PAH, perioperative management in PAH, physiology of pregnancy, anesthesia in PAH, pulmonary vasodilators.
Abstract: Pregnancy in patients with pulmonary arterial hypertension (PAH) is a high-risk condition
associated with high morbidity and mortality. Patients with severe PAH are often advised
against pregnancy. Still, those patients who pursue pregnancy require a dedicated and multidisciplinary
approach since the progression of fetal growth will accompany significant hemodynamic
changes, which can be challenging for patients with a poorly functioning right ventricle. In this article,
we describe the approach to the unique cardiovascular, respiratory, hematologic, and social
challenges that pregnant patients with PAH face throughout pregnancy. We discuss the impact of
these physiologic changes on diagnostic studies commonly used in PAH and how to incorporate
diagnostic data in making the diagnosis and risk stratifying pregnant patients with PAH. The pharmacologic
challenges of pulmonary vasodilators in pregnancy are discussed as well. Pregnant patients
with PAH are at particularly high risk of mortality around the time of delivery, and we discuss
the multidisciplinary approach to the management of these patients, including the use of anesthesia,
inotropic support, type of delivery, and postpartum care, providing clinicians with a practical
approach to the management of this difficult condition.
