Document Detail


Management of pulmonary arterial hypertension during pregnancy: a retrospective, multicenter experience.
MedLine Citation:
PMID:  23100080     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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: We conducted a retrospective evaluation of pregnant patients with PAH managed between 1999 and 2009 at five US medical centers. Patient demographics, medical therapies, hemodynamic measurements, manner of delivery, anesthetic administration, and outcomes were assessed.
RESULTS: Among 18 patients with PAH, 12 continued pregnancy and six underwent pregnancy termination. Right ventricular systolic pressure in patients managed to parturition was 82 ± 5 mm Hg and in patients with pregnancy termination was 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, IV prostanoids, or combination therapy. All parturients underwent Cesarean section at 34 weeks with one in-hospital death and one additional death 2 months postpartum for maternal mortality of 16.7%.
CONCLUSIONS: Compared with 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.
Authors:
Alexander G Duarte; Shibu Thomas; Zeenat Safdar; Fernando Torres; Luis D Pacheco; Jeremy Feldman; Bennet DeBoisblanc
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Chest     Volume:  143     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-05-10     Completed Date:  2013-08-29     Revised Date:  2013-09-04    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1330-6     Citation Subset:  AIM; IM    
Affiliation:
Pulmonary/Critical Care Medicine, The University of Texas MedicalBranch at Galveston, 301 University Blvd, Galveston, TX 77555-0561, USA. aduarte@utmb.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthetics / administration & dosage
Blood Pressure / drug effects,  physiology
Cesarean Section
Disease Management*
Female
Hemodynamics / physiology
Humans
Hypertension, Pulmonary / mortality*,  physiopathology,  therapy*
Piperazines / pharmacology,  therapeutic use
Pregnancy
Pregnancy Complications, Cardiovascular / mortality*,  physiopathology,  therapy*
Pregnancy Outcome*
Prostaglandins / pharmacology,  therapeutic use
Purines / pharmacology,  therapeutic use
Retrospective Studies
Sulfones / pharmacology,  therapeutic use
Survival Rate
Vasodilator Agents / pharmacology,  therapeutic use
Grant Support
ID/Acronym/Agency:
K23 HL093214/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Anesthetics; 0/Piperazines; 0/Prostaglandins; 0/Purines; 0/Sulfones; 0/Vasodilator Agents; 3M7OB98Y7H/sildenafil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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