| Management of pulmonary arterial hypertension during pregnancy: a retrospective, multicenter experience. | |
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MedLine Citation:
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PMID: 23100080 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare disease with a predilection for young women that is associated with right ventricular failure and premature death. PAH can complicate pregnancy with hemodynamic instability or sudden death during parturition and postpartum. Our aim was to examine the impact of PAH on pregnancy outcomes in the modern era. METHODS: Retrospective evaluation of pregnant patients with PAH managed between 1999 and 2009 at five U.S. medical centers. Patient demographics, medical therapies, hemodynamic measurements, manner of delivery, anesthetic administration and outcomes were assessed. RESULTS: Among eighteen patients with PAH, twelve continued pregnancy and six underwent pregnancy termination. Right ventricular systolic pressure (RVSP) in patients managed to parturition was 82 ± 5 mm Hg and in patients with pregnancy termination 90 ± 16 mm Hg. Six patients underwent pregnancy termination at mean gestational age of 13 ± 1.0 weeks with no maternal deaths or complications. Twelve patients elected to continue their pregnancy and were hospitalized at 29 ± 1.4 weeks. PAH-specific therapy was administered to nine (75 %) at time of delivery consisting of sildenafil, intravenous prostanoids or combination therapy. All parturients underwent Cesarean section at 34 weeks with one in-hospital death and one additional death two months postpartum for maternal mortality of 16.7 %. CONCLUSION: Compared to earlier reports, maternal morbidity and mortality among pregnant women with PAH was reduced, yet maternal complications remain significant and patients should continue to be counseled to avoid pregnancy. |
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Authors:
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Alexander G Duarte; Shibu Thomas; Zeenat Safdar; Fernando Torres; Luis D Pacheco; Jeremy Feldman; Bennet Deboisblanc |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-10-22 |
Journal Detail:
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Title: Chest Volume: - ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2012 Oct |
Date Detail:
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Created Date: 2012-10-26 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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