Management of Severe Idiopathic Pulmonary Arterial Hypertension During Pregnancy with 13 consecutive

• 作 者: Xiaohui Xu Ju Zhang Yanna Li Haofeng Zhang Yaqin Wang Hong Gu Liyun Zhao Jinglan Zhang
• 机 构: Department of Obstetrics and Gynecology, Beijing Anzhen Hosipital, Capital Medical University, Beiji
• 出 处: 2016北京地区妇产科学专业学术年会
• 发表日期: 2016年12期
• 关键词: Pregnancy cardiovascular idiopathic pulmonary arterial hypertension maternal mor

　　Objective To examine the impact of severe idiopathic pulmonary arterial hypertension (IPAH) on pregnancy outcome in modern era, and to investigate the effect of multidisciplinary approach during pregnancy on the pregnancy outcome in pregnant patients with severe IPAH.Methods We retrospectively evaluated consecutive thirteen pregnant patients with severe IPAH between March 2007 and November 2015 in Beijing Anzhen Hospital.Hemodynamic measurements, medical therapy, manner of delivery, anesthetic administration, multidisciplinary management and outcomes were assessed.Results Thirteen patients were induced in this study, and all cases were first diagnosed during the pregnancy and received multidisciplinary management.The systolic pulmonary artery pressure (SPAP) estimated by transthoracic echocardiography was (98.8± 13.5) mmHg, and the New York Heart Association (NYHA) classification was class Ⅲ for eight patients , and class Ⅳ for five patients.PAH-specific therapy was administered to all the patients consisting of sildenafil,prostanoids, or combination therapy.Three patients underwent pregnancy termination at 16, 21 and 24 weeks gestation with no maternal death or complications.Ten patients continued pregnancy and all the patients underwent caesarean section at mean gestational age of (31.6±3.7) weeks.Nine had cesarean deliveries during continuous epidural anesthesia, and one during general anesthesia.There were three maternal deaths in hospital (five, two, three days postpartum) for maternal mortality of 23%.Three fetal death related to therapeutic abortion.Ten newborns were alive without malformation and the average weight is (1832±780.4) g.Conclusions Because of maternal mortality in patients with severe IPAH remains prohibitively high, patients should continue to be counseled to avoid pregnancy.Women with severe IPAH who become pregnancy should be followed by multidisciplinary approach, and cesarean deliveries during continuous epidural anesthesia is a relatively safe way for pregnancy termination in patients with severe IPAH.