Pulmonary hypertension.

Pulmonary hypertension may be primary, of unknown etiology, or secondary to existing cardiorespiratory disease. In general, the prognosis is poor, but the superimposed physiologic changes of pregnancy, labor, and delivery may produce a lethal condition. Pregnancy prevention is better than any proposed care. If pregnancy occurs, termination is suggested in the first or early second trimesters. If the choice is to continue the pregnancy, a well-coordinated intensive management plan is necessary. This plan should include midsecond trimester hospital admission of the patient, continuous hemodynamic monitoring during the intrapartum period and immediately after delivery, and preferably elective induction with hemodynamically stable epidural anesthesia for labor and delivery.