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Updated: Feb 9, 2026
Evaluation of Right Ventricular Function in Experimental Models of Pulmonary Arterial Hypertension
Published on: June 27, 2025
ANESTHETIC MANAGEMENT AND INTENSIVE CARE DURING PERIOPERATIVE PERIOD OF ABDOMINAL DELIVERY IN PREGNANT WOMEN WITH
Insights
Pregnant women with pulmonary arterial hypertension (PAH) face high mortality risks. Perioperative management, including anesthesia and intensive care, is crucial for improving outcomes in these high-risk pregnancies.
Area of Science:
- Anesthesiology
- Cardiology
- Obstetrics
Background:
- Pulmonary arterial hypertension (PAH) in pregnancy significantly increases maternal mortality, especially with Eisenmenger syndrome.
- Limited data exists on perioperative management for pregnant women with PAH due to its rarity.
Purpose of the Study:
- To summarize anesthesia and intensive care approaches for pregnant women diagnosed with PAH.
- To evaluate outcomes and identify critical management strategies.
Main Methods:
- A retrospective study included 21 pregnant women with PAH undergoing Cesarean section (CS) between 2010-2015.
- Data collected included patient demographics, PAH severity (SPAP > 60 mm Hg), interventions, and outcomes.
Main Results:
- Most patients (81%) had PAH associated with congenital heart disease (CHD), and 57% had Eisenmenger syndrome.
- Postoperative decompensation occurred in 76.2% of cases, requiring intensive PAH-specific therapy and inotropic support.
- Mortality was 14.2%, with 25% mortality in Eisenmenger syndrome cases.
Conclusions:
- Management of pregnant women with PAH requires intensive perioperative care and specialized treatment protocols.
- High rates of postoperative complications necessitate vigilant monitoring and prompt intervention.
- Further research is needed to optimize anesthetic and critical care strategies for this vulnerable population.
Abstract:
Background The presence ofpulmonary arterial hypertension (PAH) in pregnant women increases mortality up to 12- 30% and up to 50% when PAH is associated with Eisenmenger syndrome. Due to low prevalence of PAH in pregnancy many aspects ofperioperative management are still unclear.
The Aim:
To summarize our approaches to the anesthesia and intensive care in pregnant women with PAH.
Materials And Methods:
21 pregnant women with PAH (systolic pulmonary artery pressure (SPAP) higher than 60 mm Hg)-who underwent delivery by Caesarean section in 2010 - 2015 were included in the one-centre retrospective study. Data are presented as median (25th, 75th percentile).
Results:
The median age was 27 (23; 29) years. Among the patients, there were 4 (19%) cases of idiopathic PAH and in 17 (81%) women PAH was associated with congenital heart disease (CHD); 12 (57%) patients'demonstrated Eisenmenger syndrome. Baseline SPAP was 90 (82; 103) mm Hg. SpO2 90 (85,95)%. All women taken PAH-specific therapy (sildenafil) before delivery. Caesarean section (CS) were performed at 32 (28; 34) weeks. In 20 cases CS was perfofined under epidural anesthesia and in one case under general anesthesia due thrombocytopenia. Inhaled nitric oxide (NO) was administered intraoperative to all women in a dose of 40-60 ppm. Postoperative period was uncomplicated in five women (23?8%). Decompensation with PAP rise, acute right ventricular failure and hypoxemia developed in 16 (76,2%) cases 30 (24, 40) h after abdominal delivery. These patients required combined PAH-specific therapy (NO, sldenafil, iloprost) and inotropic agents, additionallyrespiratory support was used in four patients. The median ICU stay was 13 (9; 22) days. 3 patients died (14?2%); mortality in Eisenmenger syndrome cases was 25% (3/12). 18 healthy babies.
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