Neuraxial anesthesia for surgical pregnancy termination in patients with severe pulmonary hypertension: a case series (2019-2025)

Current literature on the anesthetic management for surgical pregnancy termination in patients with pulmonary hypertension is limited to patients with pulmonary arterial hypertension using epidural or opioid-only spinal techniques. We report three cases of severe pulmonary hypertension with different etiologies undergoing surgical pregnancy termination using low-dose spinal anesthesia from 2019 to 2025. Two cases were performed in the cardiac surgery operating room with invasive blood pressure monitoring and postoperative cardiac care unit observation; one was managed in the labor and delivery operating room with standard monitoring and general floor observation. All patients were discharged on postoperative day one. This case series suggests that low-dose spinal anesthesia may be a reasonable option for surgical pregnancy termination in select patients with severe pulmonary hypertension, highlighting the importance of a multidisciplinary approach in a Level IV Maternal Care center and an anesthetic plan tailored to the pulmonary hypertension etiology and associated comorbidities.