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BJOG. 2019 Mar 14. doi: 10.1111/1471-0528.15681. [Epub ahead of print]

Outcome of pregnancies in women with Pulmonary Hypertension: A Single Centre Experience from South India.

Author information

1
Departments of Obstetrics & Gynaecology.
2
Cardiology.
3
Anaesthesiology& Critical Care, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India, 605006.

Abstract

OBJECTIVE:

To study maternal complications and pregnancy outcome in women with pulmonary hypertension, attending a tertiary centre in south India.

STUDY DESIGN:

Retrospective Observational study.

SETTING:

Tertiary centre in south India.

POPULATION:

Pregnant women with pulmonary hypertension.

METHOD:

Data regarding demographics, clinical course, medications received and echocardiographic diagnosis regarding pulmonary hypertension, and antenatal care received were collected from the records. Details of labour and delivery and post-partum follow-up were retrieved. We compared the outcome based on the presence or absence of cyanosis and right ventricular systolic pressure levels.

MAIN OUTCOME MEASURES:

Maternal mortality, Occurrence of complications such as heart failure, fetal growth restriction.

RESULTS:

There were 81 pregnancies in 73 women with pulmonary hypertension. Majority of them had pulmonary hypertension secondary to congenital heart disease (80.8%); 17.8% had Eisenmenger's syndrome. Advanced pulmonary artery hypertension (PAH) medication, Sildenafil was administered in 25(31.3%) pregnancies. There were four maternal deaths, of which three had Eisenmenger's syndrome. Heart failure complicated 6.3% and fetal growth restriction 26.3% of pregnancies. Morbidity was significantly increased in women with pulmonary hypertension associated with a cyanotic cardiac lesion or in those with right ventricular systolic pressure >70mmHg.

CONCLUSION:

Despite advances in care, mortality in pregnant women with pulmonary hypertension is a matter of concern, especially in those with Eisenmenger's syndrome. Multidisciplinary team management in tertiary centres and the use of advanced PAH medications even in low to middle-income countries with limited resources, might lead to a reduction in morbidity and mortality related to pulmonary hypertension.

FUNDING:

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. This article is protected by copyright. All rights reserved.

KEYWORDS:

Eisenmenger's syndrome; Pregnancy; Pulmonary Hypertension

PMID:
30868706
DOI:
10.1111/1471-0528.15681

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