Pulmonary hypertension in pregnancy

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Pulmonology

Background:

• Pulmonary arterial hypertension (PAH) in pregnancy presents a rare but significant high-risk scenario.
• While many women know their diagnosis pre-pregnancy, a notable portion are diagnosed during gestation.
• Termination is often advised due to elevated maternal and fetal mortality risks, yet many opt to continue the pregnancy.

Purpose of the Study:

• To review the current management strategies for pregnant patients with pulmonary arterial hypertension.
• To highlight the critical considerations for delivery and postpartum care in this high-risk population.
• To discuss the role of lung transplantation in select nonpregnant patients with PAH or Eisenmenger syndrome.

Main Methods:

• Review of current clinical practices and literature regarding pregnancy and PAH.
• Emphasis on advanced therapeutic interventions, including prostacyclin analogues.
• Focus on multidisciplinary team approach for delivery, particularly cesarean section, and postpartum monitoring.

Main Results:

• Most pregnant patients with PAH receive advanced therapies, with prostacyclin analogues being common.
• Delivery often involves cesarean section under controlled conditions by an expert team, with strict attention to volume status and blood loss.
• The postpartum period, especially the first month, represents the highest risk for maternal complications.

Conclusions:

• Managing pregnancy with PAH requires a comprehensive, multidisciplinary approach focusing on advanced medical therapy and optimized delivery strategies.
• Vigilant postpartum surveillance is crucial due to the heightened risk of maternal mortality.
• Lung transplantation is a viable option for nonpregnant individuals with severe idiopathic PAH or Eisenmenger syndrome who have poor functional status and prognosis.