Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India.
Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India.
BJOG. 2019 Aug;126 Suppl 4:43-49. doi: 10.1111/1471-0528.15681. Epub 2019 Jul 18.
To study maternal complications and pregnancy outcome in women with pulmonary hypertension, attending a tertiary centre in south India.
Retrospective observational study.
Tertiary centre in south India.
Pregnant women with pulmonary hypertension.
Data regarding demographics, clinical course, medication received, and echocardiographic diagnosis regarding pulmonary hypertension and antenatal care received were collected from the records. Details of labour and delivery, and postpartum follow up were retrieved. We compared the outcome based on the presence or absence of cyanosis and right ventricular systolic pressure levels.
Maternal mortality, occurrence of complications such as heart failure, fetal growth restriction.
There were 81 pregnancies in 73 women with pulmonary hypertension. The majority of them had pulmonary hypertension secondary to congenital heart disease (80.8%); 17.8% had Eisenmenger syndrome. An advanced pulmonary artery hypertension (PAH) medication, sildenafil, was administered in 25 (31.3%) pregnancies. There were four maternal deaths, of which three had Eisenmenger syndrome. Heart failure complicated 6.3% and fetal growth restriction 26.3% of pregnancies. Morbidity was significantly increased in women with pulmonary hypertension associated with a cyanotic cardiac lesion or with right ventricular systolic pressure >70 mmHg.
Despite advances in care, mortality in pregnant women with pulmonary hypertension is a matter of concern, especially in those with Eisenmenger syndrome. Multidisciplinary team management in tertiary centres and the use of advanced PAH medications even in low- to middle-income countries with limited resources, could lead to a reduction in morbidity and mortality related to pulmonary hypertension.
Multidisciplinary care and use of new medication may improve outcomes in pregnant women with pulmonary hypertension.
研究在印度南部一家三级中心就诊的肺动脉高压女性的产妇并发症和妊娠结局。
回顾性观察性研究。
印度南部的一家三级中心。
患有肺动脉高压的孕妇。
从病历中收集有关人口统计学、临床过程、接受的药物治疗以及关于肺动脉高压和产前保健的超声心动图诊断的数据。检索分娩和产后随访的详细信息。我们根据发绀和右心室收缩压水平的存在与否比较了结果。
产妇死亡率、心力衰竭等并发症的发生、胎儿生长受限。
在 73 名患有肺动脉高压的女性中，有 81 例妊娠。其中大多数为先天性心脏病继发肺动脉高压（80.8%）；17.8%为艾森曼格综合征。25 例（31.3%）妊娠中使用了先进的肺动脉高压（PAH）药物西地那非。有 4 例产妇死亡，其中 3 例患有艾森曼格综合征。心力衰竭并发症占 6.3%，胎儿生长受限占 26.3%。患有与发绀性心脏病变或右心室收缩压>70mmHg 相关的肺动脉高压的女性，发病率显著增加。
尽管治疗有所进步，但肺动脉高压孕妇的死亡率仍然令人担忧，尤其是患有艾森曼格综合征的孕妇。三级中心的多学科团队管理以及即使在资源有限的中低收入国家使用先进的 PAH 药物，都可能降低与肺动脉高压相关的发病率和死亡率。
多学科护理和新药物的使用可能改善肺动脉高压孕妇的结局。
