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 Table of Contents  
CASE REPORT
Year : 2012  |  Volume : 26  |  Issue : 3  |  Page : 197-198

Primary pulmonary hypertension and pregnancy


1 Associate Professor Obstetrics and Gynaecology, RIMS, Lamphel, India
2 Associate professor of Anaesthesiology, RIMS, Lamphel, India
3 Associate Professor of Cardiology, RIMS, Lamphel, India
4 Assistant Professor of Obstetrics and Gynaecology, RIMS, Lamphel, India
5 Assistant Professor of Anaesthesiology, RIMS, Lamphel, India

Date of Web Publication10-Jun-2013

Correspondence Address:
M Rameswar Singh
RIMS, Colony, Type-V, Qtr. No. 16, Lamphel
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958 .113253

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  Abstract 

Primary pulmonary hypertension is rare condition. Pregnancy with this condition is associated with high maternal mortality.

Keywords: Maternal mortality, Pregnancy, Primary pulmonary hypertension


How to cite this article:
Singh M R, Rajkumar G, Singh TD, Usharani Devi A K, Singh N R, Singh T R. Primary pulmonary hypertension and pregnancy. J Med Soc 2012;26:197-8

How to cite this URL:
Singh M R, Rajkumar G, Singh TD, Usharani Devi A K, Singh N R, Singh T R. Primary pulmonary hypertension and pregnancy. J Med Soc [serial online] 2012 [cited 2020 Oct 30];26:197-8. Available from: https://www.jmedsoc.org/text.asp?2012/26/3/197/113253


  Introduction Top


Pregnancy with pulmonary hypertension is associated with high maternal morbidity and mortality. Such a case is reported for its rarity.


  Case Report Top


A 21-year-old pregnant women (Po+o+o+o) reported to ante-natal outpatient, Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences with complaints of cough, breathlessness, palpitation, and dizziness for 5 days following 30 weeks of gestation. Examination revealed: 41 kg body weight, body mass index 19, pulse 106/min, blood pressure 90/70, chest-clear, cardiac murmur (ejection systolic at pulmonary area and systolic murmur at apex). Per abdomen examination revealed: 30 weeks size uterus, cephalic presentation, fetal heart rate was 146/min regular. Echocardiography report showed congenital heart disease, large subaortic ventricular septal defect (30.7 mm diameter) severe pulmonary artery hypertension, bidirectional shunt, mild mitral regurgitation, moderately dilated left atrium with non-dilated left ventricle, and mildly reduced left ventricular function (Eisenmenger complex). Electrocardiography showed sinus tachycardia (110/min), right axis deviation, biventricular hypertrophy. Hemoglobin is 11 g% and other hemato-biochemical reports were within normal limits. As the patient wished to continue pregnancy, the risks of the pregnancy were discussed with the patient and party and decided to continue the pregnancy. Joint-treatment with cardiologist and obstetrician was advocated. She had preterm labor at 34 weeks and pregnancy was terminated by caesarean section under spinal anesthesia using 0.8 ml of 0.5% bupivacaine. Finally, a female baby of 2 kg weight was delivered and no hypotension or any other complications were observed intraoperatively. Post-operative analgesia consisted of intramuscular injection of 50 mg of pethidine and diclofenac. The patient was transferred to the intensive care unit. Post-partum period was uneventful. She had been followed-up ever since, by cardiologist and currently, is stable but symptomatic.


  Discussion Top


Severe pulmonary hypertension is a serious disorder that can be present in women of child bearing age. During pregnancy, it is associated with morbidity and mortality in all defined clinical groups of pulmonary hypertension. Maternal mortality in pregnancy with pulmonary hypertension is 30-50%. Therefore, severe pulmonary hypertension is regarded as a contraindication for pregnancy. [1],[2] Although, pulmonary hypertension is associated with a risk of maternal mortality and most women are advised against pregnancy, new therapies may improve the outcome of pregnancy in patient with pulmonary hypertension. [3] Multi-disciplinary approach is indispensable to plan optimal treatment for patient who wished to pursue a pregnancy even though, their heart disease exposes them to a high-level of risk. Specific targeted therapy for pulmonary hypertension may be required during pregnancy. Many agents are contraindicated, because of risks of teratogenicity or secretion into breast milk. Optimal mode of delivery is not clear, but early input from high-risk obstetric anesthesia team is essential. [4] Whilst, standard text books and traditional teaching had been explained that general anesthesia is to be preferred to a regional technique, we feel that general anesthesia also poses clear risks and disadvantages. Whatever anesthetic technique is chosen, the principal remains the same. The cardiac output must be maintained and systemic vascular resistance must not be allowed to fall. This should ensure that there is minimal change in the amount of right to left shunt. Regional anesthesia has been employed successfully in this case. [5],[6] There is evidence that suggests that pregnancy and labor in a patient with idiopathic pulmonary hypertension may have a better outcome than previously reported. The decision of undertaking for continuing pregnancy in a patient with idiopathic pulmonary hypertension relies ultimately on the patient's choice, but should be on an individual basis after careful evaluation of the risks. Finally, the need of close follow-up with a multidisciplinary team is mandatory in the patient with pulmonary hypertension that wishes to undergo pregnancy. [7]

 
  References Top

1.Kiely DG, Condliffe R, Webster V, Mills GH, Wrench I, Gandhi SV, et al. Improved survival in pregnancy and pulmonary hypertension using a multiprofessional approach. BJOG 2010;117:565-74.  Back to cited text no. 1
    
2.Pieper PG, Hoendermis ES. Pregnancy in women with pulmonary hypertension. Neth Heart J 2011;19:504-8.  Back to cited text no. 2
    
3.Goland S, Tsai F, Habib M, Janmohamed M, Goodwin TM, Elkayam U. Favorable outcome of pregnancy with an elective use of epoprostenol and sildenafil in women with severe pulmonary hypertension. Cardiology 2010;115:205-8.  Back to cited text no. 3
    
4.Madden BP. Pulmonary hypertension and pregnancy. Int J Obstet Anesth 2009;18:156-64.  Back to cited text no. 4
    
5.Cole PJ, Cross MH, Dresner M. Incremental spinal anaesthesia for elective caesarean section in a patient with Eisenmenger's syndrome. Br J Anaesth 2001;86:723-6.  Back to cited text no. 5
    
6.Atanassoff P, Alon E, Schmid ER, Pasch T. Epidural anesthesia for cesarean section in a patient with severe pulmonary hypertension. Acta Anaesthesiol Scand 1989;33:75-7.  Back to cited text no. 6
    
7.Carro Jiménez EJ, López JE. Uneventful pregnancy and delivery in a patient with idiopathic pulmonary hypertension: A case report. P R Health Sci J 2006;25:283-7.  Back to cited text no. 7
    




 

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