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Pulmonary hypertension in pregnancy: A report of 49 cases
Abstract Number: F-41
Abstract Type: Original Research
Pulmonary hypertension (PH) in pregnancy carries a mortality of 25%.1 If pregnancy occurs, termination is advised.2 No study of PH in pregnancy has examined outcomes according to the WHO PH classification.3 We hypothesized that outcomes vary depending on the WHO group and PH severity.
Electronic medical record at 3 North-American institutions were used to identify all pregnancies with PH (2001-2015), defined by mean PAP>25 (mild) and mean PAP≥50 or systolic PAP≥70 (severe). Demographics, clinical characteristics, management and outcomes were identified. Women were sorted by WHO PH classification: pulmonary arterial hypertension (PAH) (WHO Group 1); left heart disease (WHO Group 2); lung disease (WHO Group 3); thrombotic disease (WHO Group 4); and multifactorial etiologies (WHO Group 5).3 Severity and treatment of PH were identified. Fisher exact test (2-tailed p-values) was used to compare differences in outcomes between the groups.
49 women were included in the study (Table). Overall mortality (death within 1 year of delivery) was 16%; for women with PAH mortality was 23%, for thrombotic disease 14%, and for left heart and lung disease 0% (although the number in the later two groups were small). For women with Eisenmenger’s syndrome (n=6) mortality was 50%. There was a non-significant trend toward higher mortality in women with severe PH versus mild PH (22% v 9%, p=0.4). Mortality was similar with vaginal (5%) or cesarean delivery (18%), p=0.44.
Neuraxial anesthesia was used in 20 of the CDs without anesthesia-related adverse events. Women with severe PH were more likely to receive advanced therapies (inotropes, pulmonary vasodilators, ECMO) than women with mild PH (65% v 32%, p=0.04). Preterm deliveries were more frequent with severe PH (82% v 47%, p=0.05). There was a 25 week IUFD, but no neonatal deaths.
This is the largest contemporary case series of PH in pregnancy. Maternal PH-related morbidity remains high despite advanced therapies. The trend toward higher mortality and preterm delivery in women with severe PH and with PAH may guide preconception and early pregnancy counseling. Experts disagree regarding the safest mode of delivery for women with PH.2,4 Our data did not show a mortality difference associated with mode of delivery.
Other authors: R. Landau, R. Smiley
1. Bédard. Euro Heart J. 2009
2. Hemnes. Pulm Circ. 2015
3. Simonneau. JACC. 2013
4. Regitz-Zagrosek. Euro Heart J. 2011