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Medical > Therapy > General measures

Pregnancy

Maternal mortality is significantly increased in patients with pulmonary vascular disease. In a retrospective analysis of 72 cases with Eisenmenger’s syndrome, 27 cases with primary pulmonary hypertension and 25 cases with secondary pulmonary hypertension, maternal mortality was 36 %, 30 % and 56 %, respectively. Neonatal survival ranged between 87 and 89 %. Using multivariate analysis, late diagnosis of pulmonary hypertension during pregnancy and late hospital admission were independent risk factors for maternal mortality. Operative delivery was a significant univariate risk factor for maternal mortality. There was a tendency for higher death rates between postpartum day 2 and 7 (Weiss et al., 1998). Postpartum decompensation is characterized by an increase in the central venous pressure, a decrease in the systemic blood pressure and hence in the coronary perfusion pressure. Vasodilators, such as nifedipine, intravenous or inhaled prostaglandins or inhaled nitric oxide were successfully used to treat or prevent pulmonary hypertension crisis during pregnancy, delivery and postpartum (Easterling et al., 1999, Goodwin et al., 1999, Badalian et al., 2000, Weiss et al., 2000, Stewart et al., 2001). Therapy with intravenous epoprostenol was well tolerated by both the mother and the fetus. Two deaths were reported despite vasodilatatory treatment. In one case, additional administration of nitric oxide was discontinued 48 hours after delivery (Goodwin et al., 1999) and in the other case, the mother was a non-responder to the vasodilatatory treatment (Easterling et al., 1999). In conclusion, women with pulmonary hypertension should avoid becoming pregnant. If diagnosis of pulmonary hypertension is made during the pregnancy, a therapy with inhaled or intravenous prostaglandins should be started as early as possible and continued for at least two weeks after delivery.

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