Calendar | For Your Patients | PHA Main Site | Contact Us | About Us | Not a registered user? Sign up here.

Resource Library

Maternal Pulmonary Hypertension: Multidisciplinary Management

Dale Monnier

Susan Fair

Donna Tucciarone

Reviews

  Sign in to add a review

0 comments
Leave a Comment

Conference: 2015 PH Professional Network Symposium

Release Date: 09.17.2015

Presentation Type: Abstracts

File Download: 2015 Symposium Abstract - 1019

File Size: (241 kb)

Download Adobe Acrobat

Purpose

Pulmonary arterial hypertension (PAH) is rare in pregnancy. Pregnancy does exacerbate PAH symptoms, increasing the risks for heart failure as well as maternal and fetal morbidity and mortality. Management of this patient and her fetus is highly complex. Vigilant care management using a multidisciplinary team approach can facilitate a positive maternal and fetal outcome.

Background

AB is a 23-year-old G1P0 who was originally diagnosed with idiopathic pulmonary arterial hypertension (PAH) at age 20 after a syncopal episode. AB medical history, in addition to PAH, includes obesity and depression. AB is unemployed, lives with her boyfriend and denies tobacco or alcohol use. She did admit to use of marijuana prior to pregnancy.

During her pregnancy, AB was counseled on the risks of carrying pregnancy to term. She was informed that the maternal mortality rate currently is around 17% with the highest risk period being postpartum. AB was counseled on termination, yet strongly desired to keep the pregnancy. Boyfriend was very supportive of her decision. She had frequent appointments throughout the pregnancy with a team of healthcare providers. Cardiac echos were done every 5 weeks to monitor PA pressures.

AB presented in Preterm Labor at 34.4 weeks with abdominal and vaginal pain. Multidisciplinary team determined that best outcome options for AB would be for her to deliver at the medical center next door to the tertiary women’s hospital. The intensive care unit had ECMO (Extracorporeal Membrane Oxygenation) capability and a medical team comfortable managing AB’s pulmonary and cardiac medical condition. Two teams from the women’s hospital relocated to the medical center to care for AB during her labor and delivery course. One team cared for mom to be and the other team cared for the newborn at delivery. Infant was transferred to the neonatal care unit for care post-delivery. AB spent the initial postpartum care in the intensive care unit at the medical facility. Once her condition improved she was transferred to the women’s facility for further care enabling her to be closer to her newborn.

Methods

Development of individualized special needs care plan utilizing a multidisciplinary team approach. Disclose the importance of ongoing communication and collaboration among the team and with the patient. Identify potential risks to mother and newborn related to pulmonary arterial hypertension during pregnancy. Team providers utilized a variety of advanced treatment modalities to facilitate positive outcome for mother and newborn.

Results

Facilitation of positive outcome for both mother and newborn with vigilant care.

Conclusion

Pulmonary arterial hypertension during pregnancy can be life threatening for both the mother and her newborn. Communication, collaboration and flexibility among the many disciplines caring for this patient succeeded in producing a positive outcome for both mother and newborn.

We have since successfully cared for two more women with pulmonary arterial hypertension and their newborns utilizing this individualized multidisciplinary team approach to care.