Herrero Tiffany, Martin Erin, Poch David S, Roeder Hilary A
a Department of Reproductive Medicine/Division of Perinatal Medicine , University of California , San Diego , CA , USA.
b Department of Anesthesiology , University of California , San Diego , CA , USA.
J Matern Fetal Neonatal Med. 2018 May;31(9):1209-1213. doi: 10.1080/14767058.2017.1312329. Epub 2017 Apr 16.
Epoprostenol, a potent vasodilator, is the treatment of choice for severe pulmonary arterial hypertension (PAH) in pregnancy. However, its inhibition of platelet aggregation increases the risk of coagulation complications with conjunctive use of anti-coagulants for thromboprophylaxis.
Case 1 demonstrates a pregnancy complicated by thrombocytopenia. Case 2 describes a pregnancy with newly diagnosed PAH at 35 weeks who delivered by repeat cesarean delivery complicated by a wound hematoma. Case 3 describes a patient who delivered at 32 weeks. She required extracorporeal membrane oxygenation and a heart-lung transplant. Her care was further complicated by severe thrombocytopenia with postpartum hemorrhage refractory to usual conservative measures.
This case series describes three patients with severe PAH in pregnancy and the range of different complications that arose from anticoagulation in the setting of epoprostenol.
依前列醇是一种强效血管扩张剂，是孕期重度肺动脉高压（PAH）的首选治疗药物。然而，其对血小板聚集的抑制作用增加了联合使用抗凝剂进行血栓预防时发生凝血并发症的风险。
病例1展示了一例并发血小板减少症的妊娠。病例2描述了一名在35周时新诊断为PAH的孕妇，通过重复剖宫产分娩，并发伤口血肿。病例3描述了一名在32周分娩的患者。她需要体外膜肺氧合和心肺移植。她的治疗因严重血小板减少症和产后出血而进一步复杂化，常规保守措施对此无效。
本病例系列描述了三名孕期重度PAH患者以及在依前列醇治疗背景下抗凝引发的一系列不同并发症。
