Perioperative management for parturients with pulmonary hypertension: experience with 30 consecutive cases

Pregnancy with pulmonary hypertension is considered to be associated with increased maternal and neonatal mortality. We retrospectively reviewed all parturients with pulmonary hypertension who registered at our hospital between 1999 and December 2008. We collected information about patient characteristics, including maternal age, gravida and para, pulmonary hypertension category, New York Heart Association (NYHA) functional class, pulmonary artery pressure, mode of delivery and type of anesthesia, use of anticoagulation and advanced therapy (nitric oxide, prostacyclin analogus, bosentan or sildenafil). The overall maternal mortality was 16.7% in puerperium, and there were four fetal/neonatal deaths (13%). Logistic regression could not identify any factors, including modes of anesthesia, mode of delivery, and categories and severity of pulmonary hypertension, that were significant predictors of mortality. Maternal mortality in parturients with pulmonary hypertension is high and women with pulmonary hypertension who become pregnant warrant a multidisciplinary approach.