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Pulmonary Hypertension and Pregnancy: A Retrospective Cohort Study of 31 Patients
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A5686 - Pulmonary Hypertension and Pregnancy: A Retrospective Cohort Study of 31 Patients
Author Block: X. Sun, J. Shi; Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China.
Rationale: Pulmonary hypertension (PH) is a rare but life-threatening condition, and pregnancy is usually contraindicated in this patient population. There are many areas of uncertainty for PH due to its rarity. Methods: Medical records were retrospectively reviewed to identify patients with coexisting HP and pregnancy or delivery at Peking Union Medical College Hospital between 2009 and 2016. PH was confirmed by either echocardiography or right heart catheterization. Demographics, characteristics of PH and pregnancy, management and outcomes were analyzed. Results: Thirty-one pregnant women with PH were identified, including 26 cases in WHO group 1, four cases of group 2 and one case of group 4. Median pregnancy duration was 24 weeks. The overall maternal mortality rate was 9.7% (3/31), the abortion rate was 45.2% (14/31), and the late fetal mortality was 29.4% (5/17). Maternal mortality was 2/13, 1/11 and 0 among women with severe, moderate and mild PH, respectively. Mortality was 2/6 and 1/16 among women with congenital heart disease and connective tissue disease. Cesarean section was performed in 20 patients, and mortality was 3/12 among women receiving cesarean section with general anesthesia. Pulmonary vascular-targeted medications were used in 15 of 24 patients with moderate or severe PH, but in none with mild PH. Conclusion: Our cohort demonstrates a relatively low maternal mortality but a high late fetal mortality, which are probably attributable to a short median pregnancy duration. Maternal mortality is associated with the severity of PH. Regional anesthesia is superior to general anesthesia for cesarean section.
Author Block: X. Sun, J. Shi; Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China.
Rationale: Pulmonary hypertension (PH) is a rare but life-threatening condition, and pregnancy is usually contraindicated in this patient population. There are many areas of uncertainty for PH due to its rarity. Methods: Medical records were retrospectively reviewed to identify patients with coexisting HP and pregnancy or delivery at Peking Union Medical College Hospital between 2009 and 2016. PH was confirmed by either echocardiography or right heart catheterization. Demographics, characteristics of PH and pregnancy, management and outcomes were analyzed. Results: Thirty-one pregnant women with PH were identified, including 26 cases in WHO group 1, four cases of group 2 and one case of group 4. Median pregnancy duration was 24 weeks. The overall maternal mortality rate was 9.7% (3/31), the abortion rate was 45.2% (14/31), and the late fetal mortality was 29.4% (5/17). Maternal mortality was 2/13, 1/11 and 0 among women with severe, moderate and mild PH, respectively. Mortality was 2/6 and 1/16 among women with congenital heart disease and connective tissue disease. Cesarean section was performed in 20 patients, and mortality was 3/12 among women receiving cesarean section with general anesthesia. Pulmonary vascular-targeted medications were used in 15 of 24 patients with moderate or severe PH, but in none with mild PH. Conclusion: Our cohort demonstrates a relatively low maternal mortality but a high late fetal mortality, which are probably attributable to a short median pregnancy duration. Maternal mortality is associated with the severity of PH. Regional anesthesia is superior to general anesthesia for cesarean section.
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