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Pulmonary Hypertension and Pregnancy: a Nationwide Analysis of Prevalence and Adverse Maternal Outcomes, 2003-2012.
Abstract Number: T-31
Abstract Type: Original Research
Background: Parturients with pulmonary hypertension (pHTN) present special challenges for obstetric anesthesiologists (Bonnin Anesthesiology 2005;102:1133). Case-series suggest that maternal mortality in women with pHTN has decreased (Duarte Chest 2013;143:1330). However, as more women with complex cardiac pathologies reach childbearing age, the prevalence of pHTN in parturients may increase. We examined temporal trends in the prevalence of pHTN in parturients and associated maternal morbidity and mortality in the United States between 2003 and 2012.
Methods: Data from the Nationwide Inpatient Sample 2003-2012 were analyzed. Non-cardiac and cardiac pHTN discharges, obstetrical outcomes, and maternal complications were identified through ICD-9-CM codes. Three obstetrical outcomes were defined: spontaneous loss (molar or ectopic pregnancy, abortion, or intra-uterine death), medical termination (aspiration, curettage or abortive intra-amniotic injection) and continuation of pregnancy until delivery. Cochran-Armitage test and adjusted logistic regression were used to test changes over time and adjusted logistic regression to assess risks of complication or death compared with non-pHTN pregnancies.
Results: During the 10-year study period, 8,525,624 pregnancies were identified, including 1,584 (1.9 per 10,000) with pHTN diagnosis (1,473 cardiac and 111 non-cardiac pHTN). Among pregnancies with pHTN, 69 were spontaneous losses (4.3%), 71 medical terminations (4.5%), and 1,444 continuations (91.2%). The prevalence of cardiac pHTN increased while non-cardiac pHTN decreased (Figure 1A). Of the parturients with pHTN, 18 (1.1%) died at discharge and 285 (18.0%) had at least 1 complication. The 3 most frequent complications were hemorrhage (7.3% of pHTN pregnancies), respiratory failure (4.9%), and kidney failure (3.3%). During the study period, the incidence of complications increased by 68% (p=0.0002) without a statistically significant change in mortality (p=0.06) (Figure 1B). Compared with similar obstetrical outcomes in pregnancies without pHTN, losses with pHTN were at higher risks of death or complications [adjusted odds ratio (aOR) 4.7, 95%CI:2.8-8.1] as were continuations [aOR=3.8:3.3-4.3] but not terminations [aOR=1.7:0.9-3.5]).
Conclusions: The prevalence of cardiac pHTN in parturients and incidence of complications have increased significantly in the United States. Programs for improving screening, counseling and management of women with pHTN are needed.