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Pulmonary Hypertension in Pregnancy

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Consults in Obstetric Anesthesiology

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Abstract

Pulmonary hypertension (PH) is a rare disorder that can affect the pregnant patient with serious consequences. The physiologic changes of pregnancy are poorly tolerated by the parturient with pulmonary hypertension and are associated with significant maternal and fetal mortality. Key elements of management that may improve outcome are early diagnosis and referral to a specialized obstetric care center. With no consensus guidelines available regarding delivery mode or anesthetic technique in patients with pulmonary hypertension, the anesthesiologist’s management should aim to normalize cardiovascular function and optimize hemodynamic stability. These goals are best accomplished in coordination with specialists in high-risk obstetrics, cardiology, pulmonary critical care, and neonatology.

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References

  1. Simonneau G, Gatzoulis MA, Adatia I, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2013;62:D34–41.

    Article  Google Scholar 

  2. Hemnes AR, Kiely DG, Cockrill BA, et al. Statement on pregnancy in pulmonary hypertension for the pulmonary vascular research institute. Pulm Circ. 2015;5:436–65.

    Article  Google Scholar 

  3. Moll M, Payne JG, Tukey MH, Farber HW. Gestational pulmonary arterial hypertension. Pulm Circ. 2015;5:730–3.

    Article  CAS  Google Scholar 

  4. Rex S, Devroe S. Anesthesia for pregnant women with pulmonary hypertension. Curr Opin Anesthesiol. 2016;29:1–9.

    Article  Google Scholar 

  5. Martinez M, Rutherford J. Pulmonary hypertension in pregnancy. Cardiol Rev. 2013;21:167–73.

    Article  Google Scholar 

  6. Obican SG, Clearly KL. Pulmonary arterial hypertension in pregnancy. Semin Perinatol. 2014;5:289–94.

    Article  Google Scholar 

  7. Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 to 1996. J Am Coll Cardiol. 1998;31:1650–7.

    Article  CAS  Google Scholar 

  8. Madden BP. Pulmonary hypertension and pregnancy. Int J Obstet Anesth. 2009;18:156–64.

    Article  CAS  Google Scholar 

  9. Jaïs X, Olsson KM, Barbera JA, et al. Pregnancy outcomes in pulmonary arterial hypertension in the modern management era. Eur Respir J. 2012;40:881–5.

    Article  Google Scholar 

  10. Bedard E, Dimpopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J. 2009;30:256–65.

    Article  Google Scholar 

  11. Duarte AG, Thomas S, Safdar Z, et al. Management of pulmonary arterial hypertension during pregnancy. Chest. 2013;143:1330–6.

    Article  Google Scholar 

  12. Ma L, Liu W, Huang Y. Perioperative management for parturients with pulmonary hypertension: experience with 30 consecutive cases. Front Med. 2012;6:307–10.

    Article  Google Scholar 

  13. Monagle J, Manikappa S, Ingram B, et al. Pulmonary hypertension and pregnancy: the experience of a tertiary institution over 15 years. Annals Cardiac Anesth. 2015;18:153–60.

    Article  Google Scholar 

  14. Pan PH, D’Angelo R. Anesthetic and analgesic management of mitral stenosis during pregnancy. Reg Anesth Pain Med. 2004;29:610–5.

    Article  Google Scholar 

  15. Gei A, Montufar-Rueda C. Pulmonary hypertension and pregnancy: an overview. Clin Obstet Gynecol. 2014;57:806–26.

    Article  Google Scholar 

  16. Bassily-Marcs AM, Yuan C, Oropello J, et al. Pulmonary hypertension in pregnancy: critical care management. Pulm Med. 2012;2012:9.

    Google Scholar 

  17. Belfort MA, Rokey R, Saade GR, Moise KJ Jr. Rapid echocardiographic assessment of left and right heart hemodynamics in critically ill obstetric patients. Am J Obstet Gynecol. 1994;171:884–92.

    Article  CAS  Google Scholar 

  18. Penning S, Robinson KD, Major CA, Garite TJ. A comparison of echocardiography and pulmonary artery catheterization for evaluation of pulmonary artery pressures in pregnancy patients with suspected pulmonary hypertension. Am J Obstet Gynecol. 2001;184:1568–70.

    Article  CAS  Google Scholar 

  19. Galiè N, Corris PA, Frost A, et al. Updated treatment algorithm of pulmonary arterial hypertension. J Am Coll Cardiol. 2013;62:D60–72.

    Article  Google Scholar 

  20. Goland S, Tsai F, Habib M, et al. Favorable outcome of pregnancy with an elective use of epoprostenol and sildenafil in women with severe pulmonary hypertension. Cardiology. 2010;115:205–8.

    Article  Google Scholar 

  21. Decoene C, Bourzoufi K, Moreau D, et al. Use of inhaled nitric oxide for emergency cesarean section in a woman with unexpected primary pulmonary hypertension. Can J Anaesth. 2001;48:584–7.

    Article  CAS  Google Scholar 

  22. Pieper PG, Lameijer H, Hoendermis ES. Pregnancy and pulmonary hypertension. Best Pract Res Clin Obstet Gynaecol. 2014;28:579–91.

    Article  Google Scholar 

  23. Maxwell BG, El-Sayed YY, Riley ET, Carvalho B. Peripartum outcomes and anaesthetic management of parturients with moderate to complex congenital heart disease or pulmonary hypertension. Anaesthesia. 2013;68:52–9.

    Article  CAS  Google Scholar 

  24. Sakuraba S, Kiyama S, Ochiai R, et al. Continuous spinal anesthesia and postoperative analgesia for elective cesarean section in a parturient with Eisenmenger’s syndrome. J Anesth. 2004;18:300–3.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, PennState Health Milton S. Hershey Medical Center, Hershey, PA, USA

    Kristin Brennan M.D.

  2. Department of Anesthesiology, Wake Forest Baptist Hospital, Winston Salem, NC, USA

    David Matthews Hatch M.D.

Authors
  1. Kristin Brennan M.D.
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  2. David Matthews Hatch M.D.
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Corresponding author

Correspondence to David Matthews Hatch M.D. .

Editor information

Editors and Affiliations

  1. Associate Professor, Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA

    Suzanne K. W. Mankowitz

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Brennan, K., Hatch, D.M. (2018). Pulmonary Hypertension in Pregnancy. In: Mankowitz, S. (eds) Consults in Obstetric Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-59680-8_134

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  • DOI: https://doi.org/10.1007/978-3-319-59680-8_134

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59679-2

  • Online ISBN: 978-3-319-59680-8

  • eBook Packages: MedicineMedicine (R0)

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