Outcomes and Mode of Delivery in Pulmonary Hypertension
This relatively large study by Meng et al. (Obstetrics Gynecology, 2017) aimed to determine if pregnancy outcomes vary by cause and severity of pulmonary hypertension, mode of delivery and whether modern therapies affect outcomes.
Retrospective Cohort Study
Even with advanced intensive care and therapies, mortality was still high among the 49 women surveyed, at 16%, and all deaths occurred postpartum. Not surprisingly, mortality was higher in the severe pulmonary hypertension group (mean pulmonary artery pressure ≥ 50 mm Hg or systolic pulmonary artery pressure ≥ 70 mm Hg) at 18% (4/22), compared to 5% (1/19) among women with mild pulmonary hypertension (mean pulmonary artery pressure 25-49 mm Hg). C-sections mortality rate was 18% (4/22) compared to 5% for vaginal delivery (1/19). Neuraxial anesthesia was performed in 20/22 C-sections and 17/19 vaginal births without incident. Women suffering from severe pulmonary hypertension required more advanced therapies, such as inotropes, pulmonary vasodilators, and extracorporeal membrane oxygenation, than those with mild pulmonary hypertension (73% vs. 31.8%). Women with severe pulmonary hypertension had almost double the rates of preterm delivery compared to the group with mild pulmonary hypertension (82.6% vs. 47.1%) with no neonatal deaths reported. The authors suggest that in a carefully selected subset of women with pulmonary hypertension, vaginal delivery should be considered.
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