Pulmonary Hypertension Complicating Pregnancy

Abstract

Purpose of review This study aims to describe the pathophysiology of pregnancy in pulmonary hypertension (PH) and review recent literature on maternal and fetal outcomes. Recent findings There is an increasing number of pregnant women with PH. Maternal mortality in pulmonary arterial hyperten-sion (PAH) ranges from 9 to 25%, most commonly from heart failure and arrythmias. The highest risk of death is peri-partum and post-partum. Fetal/neonatal morbidity and mortality are also substantial. There are high rates of prematurity, intrauterine growth retardation, and preeclampsia. Women should be referred to expert centers for management. Combination PAH therapy with parenteral prostacyclin and a phosphodiesterase type V inhibitor is recommended. Induced vaginal delivery is preferred, except in cases of severe heart failure or obstetric indications for cesarean section. Summary Despite advances in management, pregnancy in PAH remains a high-risk condition and should be prevented. Keywords Pulmonary hypertension. Pregnancy. Right ventricle. Heart disease Pulmonary hypertension (PH) in pregnancy is among the most serious challenges in medicine. The potential consequences to both mother and fetus can be devastating. Despite advances in medical therapy and care of high-risk pregnancy, PH during gestation remains a dangerous clinical scenario requiring a comprehensive multidisciplinary management strategy to optimize outcomes. In this review, we summarize the current state of knowledge of this problem, highlighting areas of uncertainty.