Pulmonary hypertension: Clinical parameters of a difficult case in pregnancy

Abstract

Treatment of pulmonary hypertension in pregnancy with a prostacyclin analogue-iloprost and/or calcium channel antagonists appears to improve outcomes and survival. These medications could have been administered to the patient and the response monitored. If the patient did not respond to therapy, this patient may have had either a referral to or transfer to another high risk center with more experience in this type of pregnant patient. There is no literature to support termination of pregnancy improving maternal survival outcomes in these patients, even though termination is recommended by all obstetrical textbooks. Maternal survival, rather, appears to be related to response to therapy, type of therapy, and continuation of therapy.

Summary: A patient who is pregnant with pulmonary hypertension (increased right-sided heart pressures) may be managed with medications. There is no literature to support termination of pregnancy improving maternal survival outcomes in patients with pulmonary hypertension, even though termination is recommended by all obstetrical textbooks. Maternal survival, rather, appears to be related to response to therapy, type of therapy, and continuation of therapy.

Keywords:

• Pregnancy
• Pulmonary hypertension

Additional information

Notes on contributors

Byron C. Calhoun

Dr. Calhoun serves as Professor and Vice Chair in the Department of Obstetrics and Gynecology at West Virginia University-Charleston and is directly involved in resident and medical student education. He is a diplomate of the American Board of Obstetrics and Gynecology with board certification in general Obstetrics and Gynecology, in the sub-specialty of Maternal-Fetal Medicine, and is also board certified in Addictions Medicine.