An approach to the pregnant patient with pulmonary hypertension

Abstract

Pulmonary hypertension (PH) in pregnancy is rare, with an incidence of 0.7 per 100 000 pregnancies.¹ In PH there is a constant increase in pulmonary arterial pressure and pulmonary vascular resistance (PVR). There is a decreased prostacyclin and nitric oxide (NO) production and increased thromboxane production.² This leads to failure of the right ventricle and eventually death.³ PH in pregnancy is associated with a high mortality rate, previously found to be 30–50%, but decreased in recent reviews (16–25%).^4-6 The mortality rate for women with Eisenmenger’s syndrome is 30–70%.² Most literature still advocates for women of childbearing age with PH not to fall pregnant, or terminate a pregnancy early in the first trimester.^4,6-8 However, some patients will only be diagnosed during pregnancy or still choose to become pregnant. These patients require a multidisciplinary team approach to their management regarding pregnancy and delivery.