Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center
(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmo...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Journal of Cardiovascular Development and Disease |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2308-3425/9/6/195 |
| _version_ | 1797486069010137088 |
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| author | Anjali Vaidya Estefania Oliveros Wadia Mulla Diana Feinstein Laura Hart Paul Forfia |
| author_facet | Anjali Vaidya Estefania Oliveros Wadia Mulla Diana Feinstein Laura Hart Paul Forfia |
| author_sort | Anjali Vaidya |
| collection | DOAJ |
| description | (1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension (PH) center from 2013 to 2021. (3) Results: seven pregnancies in six women with PAH, ranging from low to high risk and 21 to 37 years old. Half had known pre-existing PAH before pregnancy. One had a multifetal gestation, and one was pregnant twice under our care. PH medical therapy and serial clinical assessment throughout pregnancy were implemented with focused attention on optimizing right heart function. Delivery was planned by a multidisciplinary team involving PH cardiology, maternal fetal medicine, and obstetric anesthesiology. Patients delivered between 31 and 40 weeks of gestation; five of the seven were via cesarean section. All received regional anesthesia and were monitored in the PH intermediate step-down unit after delivery until discharge. In all cases, delivery was without complications with excellent outcomes for the mother and child. (4) Conclusions: Multidisciplinary and tailored management of PAH in pregnancy, emphasizing optimized right heart function prior to delivery, can result in excellent clinical outcomes in a referral PH center. |
| first_indexed | 2024-03-09T23:28:55Z |
| format | Article |
| id | doaj.art-0c51ff9913804b3e97399598cc311902 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-09T23:28:55Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-0c51ff9913804b3e97399598cc3119022023-11-23T17:12:47ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252022-06-019619510.3390/jcdd9060195Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited CenterAnjali Vaidya0Estefania Oliveros1Wadia Mulla2Diana Feinstein3Laura Hart4Paul Forfia5Pulmonary Hypertension, Right Heart Failure, CTEPH Program, Temple Heart and Vascular Institute, Department of Medicine, Temple University Hospital, Philadelphia, PA 19197, USAPulmonary Hypertension, Right Heart Failure, CTEPH Program, Temple Heart and Vascular Institute, Department of Medicine, Temple University Hospital, Philadelphia, PA 19197, USADivision of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, Philadelphia, PA 19197, USAObstetric Anesthesiology, Department of Anesthesiology, Temple University Hospital, Philadelphia, PA 19197, USADivision of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, Philadelphia, PA 19197, USAPulmonary Hypertension, Right Heart Failure, CTEPH Program, Temple Heart and Vascular Institute, Department of Medicine, Temple University Hospital, Philadelphia, PA 19197, USA(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension (PH) center from 2013 to 2021. (3) Results: seven pregnancies in six women with PAH, ranging from low to high risk and 21 to 37 years old. Half had known pre-existing PAH before pregnancy. One had a multifetal gestation, and one was pregnant twice under our care. PH medical therapy and serial clinical assessment throughout pregnancy were implemented with focused attention on optimizing right heart function. Delivery was planned by a multidisciplinary team involving PH cardiology, maternal fetal medicine, and obstetric anesthesiology. Patients delivered between 31 and 40 weeks of gestation; five of the seven were via cesarean section. All received regional anesthesia and were monitored in the PH intermediate step-down unit after delivery until discharge. In all cases, delivery was without complications with excellent outcomes for the mother and child. (4) Conclusions: Multidisciplinary and tailored management of PAH in pregnancy, emphasizing optimized right heart function prior to delivery, can result in excellent clinical outcomes in a referral PH center.https://www.mdpi.com/2308-3425/9/6/195pulmonary hypertensionpregnancyright ventricular dysfunctionright heart failurematernal fetal medicinecardio-obstetrics |
| spellingShingle | Anjali Vaidya Estefania Oliveros Wadia Mulla Diana Feinstein Laura Hart Paul Forfia Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center Journal of Cardiovascular Development and Disease pulmonary hypertension pregnancy right ventricular dysfunction right heart failure maternal fetal medicine cardio-obstetrics |
| title | Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center |
| title_full | Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center |
| title_fullStr | Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center |
| title_full_unstemmed | Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center |
| title_short | Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center |
| title_sort | management of pulmonary arterial hypertension in pregnancy experience from a nationally accredited center |
| topic | pulmonary hypertension pregnancy right ventricular dysfunction right heart failure maternal fetal medicine cardio-obstetrics |
| url | https://www.mdpi.com/2308-3425/9/6/195 |
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