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Pulmonary Hypertension

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Principles and Practice of Maternal Critical Care

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Abstract

Pulmonary hypertension (PH) is associated with extremely high maternal morbidity and mortality in pregnancy. Maternal mortality is reported to be between 16 and 56% depending on severity and etiology. In the past, women with PH were cautioned to avoid pregnancy. New data suggests that due to recent advances in care, the survival of women with mild PH has improved. Vaginal delivery may have comparable outcomes to cesarean delivery in this population. However, women who require intrapartum cesarean delivery are at the highest risk of morbidity and mortality. This chapter suggests therapeutic protocols based on available data and expert opinion when data is scarce.

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References

  1. Badesch DB, Champion HC, Sanchez MA, Hoeper MM, Loyd JE, Manes A, et al. Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2009;54(1 Suppl):S55–66.

    Article  PubMed  Google Scholar 

  2. Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25). Suppl:D34–41.

    Article  PubMed  Google Scholar 

  3. 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):1650–7.

    Article  CAS  PubMed  Google Scholar 

  4. Bonnin M, Mercier FJ, Sitbon O, Roger-Christoph S, Jaïs X, Humbert M, et al. Severe pulmonary hypertension during pregnancy. Anesthesiology. 2005;102(6):1133–7.

    Article  PubMed  Google Scholar 

  5. Hsu CH, Gomberg-Maitland M, Glassner C, Chen JH. The management of pregnancy and pregnancy-related medical conditions in pulmonary arterial hypertension patients. Int J Clin Pract Suppl. 2011(172):6–14.

    Google Scholar 

  6. Jaïs X, Olsson KM, Barbera JA, Blanco I, Torbicki A, Peacock A, et al. Pregnancy outcomes in pulmonary arterial hypertension in the modern management era. Eur Respir J. 2012;40(4):881–5.

    Article  PubMed  Google Scholar 

  7. 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):256–65.

    Article  PubMed  Google Scholar 

  8. Gleicher N, Midwall J, Hochberger D, Jaffin H. Eisenmenger’s syndrome and pregnancy. Obstet Gynecol Surv. 1979;34(10):721–41.

    Article  CAS  PubMed  Google Scholar 

  9. Meng ML, Landau R, Viktorsdottir O, Banayan J, Grant T, Bateman B, et al. Pulmonary hypertension in pregnancy: a report of 49 cases at four tertiary North American sites. Obstet Gynecol. 2017;129(3):511–20.

    Article  PubMed  Google Scholar 

  10. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119.

    Article  PubMed  Google Scholar 

  11. Hemnes AR, Kiely DG, Cockrill BA, Safdar Z, Wilson VJ, Al Hazmi M, et al. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute. Pulm Circ. 2015;5(3):435–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Knight MKJ, Spark P, Brocklehurst P. United Kingdom Obstetric Surveillance System (UKOSS) annual report 2007. Oxford: National Perinatal Epidemiology Unit; 2007.

    Google Scholar 

  13. Badesch DB, Raskob GE, Elliott CG, Krichman AM, Farber HW, Frost AE, et al. Pulmonary arterial hypertension: baseline characteristics from the REVEAL registry. Chest. 2010;137(2):376–87.

    Article  PubMed  Google Scholar 

  14. Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, et al. Pulmonary arterial hypertension in France: results from a national registry. Am J Respir Crit Care Med. 2006;173(9):1023–30.

    Article  PubMed  Google Scholar 

  15. McLaughlin VV, Shah SJ, Souza R, Humbert M. Management of pulmonary arterial hypertension. J Am Coll Cardiol. 2015;65(18):1976–97.

    Article  PubMed  Google Scholar 

  16. Galiè N, Humbert M, Vachiery J-L, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2015;46:903–75.

    Google Scholar 

  17. Yuan JX, Rubin LJ. Pathogenesis of pulmonary arterial hypertension: the need for multiple hits. Circulation. 2005;111(5):534–8.

    Article  PubMed  Google Scholar 

  18. Machado RD, James V, Southwood M, Harrison RE, Atkinson C, Stewart S, et al. Investigation of second genetic hits at the BMPR2 locus as a modulator of disease progression in familial pulmonary arterial hypertension. Circulation. 2005;111(5):607–13.

    Article  CAS  PubMed  Google Scholar 

  19. Austin ED, Loyd JE. Genetics and mediators in pulmonary arterial hypertension. Clin Chest Med. 2007;28(1):43–57, vii–viii

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ma L, Liu W, Huang Y. Perioperative management for parturients with pulmonary hypertension: experience with 30 consecutive cases. Front Med. 2012;6(3):307–10.

    Article  PubMed  Google Scholar 

  21. Toro K, Herjavecz I, Vereckei E, Kovacs M. Fatal idiopathic pulmonary haemosiderosis in association with pregnancy - medico-legal evaluation. J Forensic Legal Med. 2012;19(2):101–4.

    Article  Google Scholar 

  22. Ouzounian JG, Elkayam U. Physiologic changes during normal pregnancy and delivery. Cardiol Clin. 2012;30(3):317–29.

    Article  PubMed  Google Scholar 

  23. Chin KM, Kim NH, Rubin LJ. The right ventricle in pulmonary hypertension. Coron Artery Dis. 2005;16(1):13–8.

    Article  PubMed  Google Scholar 

  24. European Society of Group, Association for European Paediatric Committee, German Society for Gender M, Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the task force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147–97.

    Article  Google Scholar 

  25. Pieper PG, Lameijer H, Hoendermis ES. Pregnancy and pulmonary hypertension. Best Pract Res Clin Obstet Gynaecol. 2014;28(4):579–91.

    Article  PubMed  Google Scholar 

  26. Bates SM, Middeldorp S, Rodger M, James AH, Greer I. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):92–128.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Rosengarten D, Kramer MR. Pregnancy in pulmonary arterial hypertension patients. Harefuah. 2013;152(9):547–51, 63, 62.

    PubMed  Google Scholar 

  28. D’Alton ME, Friedman AM, Smiley RM, Montgomery DM, Paidas MJ, D’Oria R, et al. National Partnership for Maternal Safety: consensus bundle on venous thromboembolism. Anesth Analg. 2016;123(4):942–9.

    Article  PubMed  Google Scholar 

  29. Leffert L, Butwick A, Carvalho B, Arendt K, Bates SM, Friedman A, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants. Anesth Analg. 2018;126(3):928–44.

    Article  PubMed  Google Scholar 

  30. Tremblay JA, Couture EJ, Albert M, Beaubien-Souligny W, Elmi-Sarabi M, Lamarche Y, et al. Noninvasive administration of inhaled nitric oxide and its hemodynamic effects in patients with acute right ventricular dysfunction. J Cardiothorac Vasc Anesth. 2019;33(3):642–7.

    Article  CAS  PubMed  Google Scholar 

  31. Zamanian RT, Haddad F, Doyle RL, Weinacker AB. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med. 2007;35(9):2037–50.

    Article  PubMed  Google Scholar 

  32. Duarte AG, Thomas S, Safdar Z, Torres F, Pacheco LD, Feldman J. Management of pulmonary arterial hypertension during pregnancy: a retrospective, multicenter experience. Chest J. 2013;143(5):1330–6.

    Article  Google Scholar 

  33. Rosenzweig EB, Brodie D, Abrams DC, Agerstrand CL, Bacchetta M. Extracorporeal membrane oxygenation as a novel bridging strategy for acute right heart failure in group 1 pulmonary arterial hypertension. ASAIO J. 2014;60(1):129–33.

    Article  CAS  PubMed  Google Scholar 

  34. Agerstrand C, Abrams D, Biscotti M, Moroz L, Rosenzweig EB, D’Alton M, et al. Extracorporeal membrane oxygenation for cardiopulmonary failure during pregnancy and postpartum. Ann Thorac Surg. 2016;102(3):774–9.

    Article  PubMed  Google Scholar 

  35. Weeks SK, Smith JB. Obstetric anaesthesia in patients with primary pulmonary hypertension. Can J Anaesth. 1991;38(7):814–6.

    Article  CAS  PubMed  Google Scholar 

  36. Barash PG, Nardi D, Hammond G, Walker-Smith G, Capuano D, Laks H, et al. Catheter-induced pulmonary artery perforation. Mechanisms, management, and modifications. J Thorac Cardiovasc Surg. 1981;82(1):5–12.

    Article  CAS  PubMed  Google Scholar 

  37. Cowie B, Kluger R, Rex S, Missant C. The utility of transoesophageal echocardiography for estimating right ventricular systolic pressure. Anaesthesia. 2015;70(3):258–63.

    Article  CAS  PubMed  Google Scholar 

  38. Penning S, Robinson KD, Major CA, Garite TJ. A comparison of echocardiography and pulmonary artery catheterization for evaluation of pulmonary artery pressures in pregnant patients with suspected pulmonary hypertension. Am J Obstet Gynecol. 2001;184(7):1568–70.

    Article  CAS  PubMed  Google Scholar 

  39. Dennis AT, Dyer RA. Cardiac output monitoring in obstetric anaesthesia. Int J Obstet Anesth. 2014;23(1):1–3.

    Article  CAS  PubMed  Google Scholar 

  40. Zanjani KS. Platelets in pulmonary hypertension: a causative role or a simple association? Iran J Pediatr. 2012;22(2):145–57.

    PubMed  PubMed Central  Google Scholar 

  41. Herve P, Humbert M, Sitbon O, Parent F, Nunes H, Legal C, et al. Pathobiology of pulmonary hypertension. The role of platelets and thrombosis. Clin Chest Med. 2001;22(3):451–8.

    Article  CAS  PubMed  Google Scholar 

  42. Gomar C, Errando CL. Neuroaxial anaesthesia in obstetrical patients with cardiac disease. Curr Opin Anaesthesiol. 2005;18(5):507–12.

    Article  PubMed  Google Scholar 

  43. Blaise G, Langleben D, Hubert B. Pulmonary arterial hypertension: pathophysiology and anesthetic approach. Anesthesiology. 2003;99(6):1415–32.

    Article  PubMed  Google Scholar 

  44. Jenkins J, Lynn A, Edmonds J, Barker G. Effects of mechanical ventilation on cardiopulmonary function in children after open-heart surgery. Crit Care Med. 1985;13(2):77–80.

    Article  CAS  PubMed  Google Scholar 

  45. Monnery L, Nanson J, Charlton G. Primary pulmonary hypertension in pregnancy; a role for novel vasodilators. Br J Anaesth. 2001;87(2):295–8.

    Article  CAS  PubMed  Google Scholar 

  46. O’Hare R, McLoughlin C, Milligan K, McNamee D, Sidhu H. Anaesthesia for caesarean section in the presence of severe primary pulmonary hypertension. Br J Anaesth. 1998;81(5):790–2.

    Article  PubMed  Google Scholar 

  47. Cauldwell M, Steer PJ, Swan L, Uebing A, Gatzoulis MA, Johnson MR. The management of the third stage of labour in women with heart disease. Heart. 2017;103(12):945–51.

    Article  CAS  PubMed  Google Scholar 

  48. Curry R, Fletcher C, Gelson E, Gatzoulis M, Woolnough M, Richards N, et al. Pulmonary hypertension and pregnancy—a review of 12 pregnancies in nine women. BJOG Int J Obstet Gynaecol. 2012;119(6):752–61.

    Article  CAS  Google Scholar 

  49. Roberts NV, Keast PJ. Pulmonary hypertension and pregnancy—a lethal combination. Anaesth Intensive Care. 1990;18(3):366–74.

    Article  CAS  PubMed  Google Scholar 

  50. Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515–21.

    Article  CAS  PubMed  Google Scholar 

  51. Presbitero P, Somerville J, Stone S, Aruta E, Spiegelhalter D, Rabajoli F. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation. 1994;89(6):2673–6.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

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

    Marie-Louise Meng & Elena Reitman

Authors
  1. Marie-Louise Meng
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  2. Elena Reitman
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Corresponding author

Correspondence to Elena Reitman .

Editor information

Editors and Affiliations

  1. Intensive Care Unit, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel

    Sharon Einav

  2. Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Carolyn F. Weiniger

  3. Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA

    Ruth Landau

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Meng, ML., Reitman, E. (2020). Pulmonary Hypertension. In: Einav, S., Weiniger, C.F., Landau, R. (eds) Principles and Practice of Maternal Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-43477-9_12

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  • DOI: https://doi.org/10.1007/978-3-030-43477-9_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43476-2

  • Online ISBN: 978-3-030-43477-9

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