Skip to main content
Log in

Perioperative management for parturients with pulmonary hypertension: experience with 30 consecutive cases

  • Research Article
  • Published:
Frontiers of Medicine Aims and scope Submit manuscript

An Erratum to this article was published on 31 August 2013

Abstract

Pregnancy with pulmonary hypertension is considered to be associated with increased maternal and neonatal mortality. We retrospectively reviewed all parturients with pulmonary hypertension who registered at our hospital between 1999 and December 2008. We collected information about patient characteristics, including maternal age, gravida and para, pulmonary hypertension category, New York Heart Association (NYHA) functional class, pulmonary artery pressure, mode of delivery and type of anesthesia, use of anticoagulation and advanced therapy (nitric oxide, prostacyclin analogus, bosentan or sildenafil). The overall maternal mortality was 16.7% in puerperium, and there were four fetal/neonatal deaths (13%). Logistic regression could not identify any factors, including modes of anesthesia, mode of delivery, and categories and severity of pulmonary hypertension, that were significant predictors of mortality. Maternal mortality in parturients with pulmonary hypertension is high and women with pulmonary hypertension who become pregnant warrant a multidisciplinary approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gaine SP, Rubin LJ. Primary pulmonary hypertension. Lancet 1998; 352(9129): 719–725

    Article  PubMed  CAS  Google Scholar 

  2. Humbert M, Sitbon O, Simonneau G. Treatment of pulmonary arterial hypertension. N Engl J Med 2004; 351(14): 1425–1436

    Article  PubMed  CAS  Google Scholar 

  3. Weiss BM, Hess OM. Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives. Eur Heart J 2000; 21(2): 104–115

    Article  PubMed  CAS  Google Scholar 

  4. Warnes CA. Pregnancy and pulmonary hypertension. Int J Cardiol 2004; 97(Suppl 1): 11–13

    Article  PubMed  Google Scholar 

  5. Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol 1998; 31(7): 1650–1657

    Article  PubMed  CAS  Google Scholar 

  6. Yentis SM, Steer PJ, Plaat F. Eisenmenger’s syndrome in pregnancy: maternal and fetal mortality in the 1990s. Br J Obstet Gynaecol 1998; 105(8): 921–922

    Article  PubMed  CAS  Google Scholar 

  7. Simonneau G, Galiè N, Rubin LJ, Langleben D, Seeger W, Domenighetti G, Gibbs S, Lebrec D, Speich R, Beghetti M, Rich S, Fishman A. Clinical classification of pulmonary hypertension. J Am Coll Cardiol 2004; 43(12 Suppl): S5–S 12

    Article  Google Scholar 

  8. Gleicher N, Midwall J, Hochberger D, Jaffin H. Eisenmenger’s syndrome and pregnancy. Obstet Gynecol Surv 1979; 34(10): 721–741

    Article  PubMed  CAS  Google Scholar 

  9. Curry RA, Fletcher C, Gelson E, Gatzoulis MA, Woolnough M, Richards N, Swan L, Steer PJ, Johnson MR. Pulmonary hypertension and pregnancy-a review of 12 pregnancies in nine women. BJOG 2012; 119(6): 752–761

    Article  PubMed  CAS  Google Scholar 

  10. Ghai B, Mohan V, Khetarpal M, Malhotra N. Epidural anesthesia for cesarean section in a patient with Eisenmenger’s syndrome. Int J Obstet Anesth 2002; 11(1): 44–47

    Article  PubMed  CAS  Google Scholar 

  11. Olofsson C, Bremme K, Forssell G, Ohqvist G. Cesarean section under epidural ropivacaine 0.75% in a parturient with severe pulmonary hypertension. Acta Anaesthesiol Scand 2001; 45(2): 258–260

    PubMed  CAS  Google Scholar 

  12. Diller GP, Gatzoulis MA. Pulmonary vascular disease in adults with congenital heart disease. Circulation 2007; 115(8): 1039–1050

    Article  PubMed  Google Scholar 

  13. Steer PJ. Pregnancy and contraception. In: Gatzoulis MA, Swan L, Therrien J, Pantely GA. Adult Congenital Heart Disease: A Practical Guide. Oxford: BMJ Publishing, Blackwell Publishing, 2005: 16–35

    Google Scholar 

  14. Bédard E, Dimopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J 2009; 30(3): 256–265

    Article  PubMed  Google Scholar 

  15. Monnery L, Nanson J, Charlton G. Primary pulmonary hypertension in pregnancy; a role for novel vasodilators. Br J Anaesth 2001; 87(2): 295–298

    Article  PubMed  CAS  Google Scholar 

  16. Coskun D, Mahli A, Korkmaz S, Demir FS, Inan GK, Erer D, Ozdogan ME. Anaesthesia for caesarean section in the presence of multivalvular heart disease and severe pulmonary hypertension: a case report. Cases J 2009; 2(1): 9383

    Article  PubMed  Google Scholar 

  17. Robinson DE, Leicht CH. Epidural analgesia with low-dose bupivacaine and fentanyl for labor and delivery in a parturient with severe pulmonary hypertension. Anesthesiology 1988; 68(2): 285–288

    Article  PubMed  CAS  Google Scholar 

  18. Khan MJ, Bhatt SB, Kryc JJ. Anesthetic considerations for parturients with primary pulmonary hypertension: review of the literature and clinical presentation. Int J Obstet Anesth 1996; 5(1): 36–42

    Article  PubMed  CAS  Google Scholar 

  19. Rimaitis K, Aliuškevičienė A, Adukauskienė D, Rimaitis M, Macas A. Cesarean delivery in severe pulmonary hypertension: a case report. Medicina (Kaunas) 2012; 48(3): 159–162

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yuguang Huang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ma, L., Liu, W. & Huang, Y. Perioperative management for parturients with pulmonary hypertension: experience with 30 consecutive cases. Front. Med. 6, 307–310 (2012). https://doi.org/10.1007/s11684-012-0209-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11684-012-0209-3

Keywords

Navigation