Conference: 2010 International PHA Conference and Scientific Sessions
Release Date: 06.24.2010
Presentation Type: Abstracts
University of the Philippines-Philippine General Hospital, Manila, Philippines
BACKGROUND: Pulmonary Hypertension is not well-tolerated in pregnancy. Symptoms may include fatigue, dyspnea, chest pain, cough, or syncope. Decompensation typically occurs in the second trimester. The normal physiologic and hemodynamic changes of pregnancy and labor put significant burden on the cardiopulmonary system, especially in the presence of increased pulmonary vascular resistance. Successful deliveries by vaginal and caesarean section have been described. But can still have a significant morbidity and mortality.
METHODS: Pregnant patients with clinical evidence suggestive for pulmonary hypertension were chosen for the study. A review of the clinical profile of patients was done. Patients were monitored and observed during pregnancy until time of delivery and subsequent hospital discharge or death
RESULTS: 4 cases were referred in 1 year period, ranging from 27–32 years old. The predominant symptom was exertional dyspnea which started before pregnancy. One patient had hemoptysis which resolved postpartum. Other complaints were cough, throat irritation, hoarseness, chest pain. The clinical suspicion was supported by 2D-Echocardiography and Chest X-ray. No patients underwent right-heart catheterization. They were given a calcium channel blocker or a phosphodiesterase-5 inhibitor. O2 support was given via nasal cannula or face mask, and monitored by pulse oxymetry. 1 patient received anticoagulation with heparin daily which was later shifted to SC enoxaparin. 1 patient had ventricular septal defect with systemic lupus erythematosus. Another had pulmonary tuberculosis with bronchiectasis. 2 patients had limited funds to complete work-ups to reach a probable cause of the condition. They were admitted within 4 weeks before delivery; 2 of which delivered within 24 hours of admission. 1 reached term pregnancy, while the rest delivered at 35th–36th wk AOG. 3 patients delivered vaginally under epidural anesthesia, 2 of which were by way of assisted outlet forceps extraction; 2 were later discharged, while 1 patient who delivered via forceps extraction died 5 days post-partum. 1 patient delivered via caesarean section for maternal-fetal indications under general anesthesia and died 2 days post-partum. All the babies survived the delivery. All patients stayed in an intensive care unit pre- and post-delivery for close monitoring.
CONCLUSION: Pulmonary hypertension continues to have a high mortality rate even after successful delivery of the fetus. Patients in the lower socioeconomic class are greatly affected by limited resources in order to arrive at an appropriate diagnostic and therapeutic management.