CHEST
Volume 119, Issue 3, March 2001, Pages 973-975
Journal home page for CHEST

Selected Reports
Pregnancy and Primary Pulmonary Hypertension: Successful Outcome With Epoprostenol Therapy

https://doi.org/10.1378/chest.119.3.973Get rights and content

Primary pulmonary hypertension (PPH) associated with pregnancycarries a high maternal mortality rate. Short-term epoprostenolinfusion has been demonstrated to improve the hemodynamic profile inpatients with PPH. We report a successful maternal-fetal outcome with epoprostenol therapy during pregnancy, cesarean section, and postpartumin a patient with PPH. Epoprostenol therapy did not produce anyphysical or developmental abnormalities in the fetus. A favorablematernal-fetal outcome may occur with a multidisciplinaryapproach.

Section snippets

Case Report

A 35-year-old, gravida (G2,P0) patient with a history of hypothyroidism presented at 26 weeks' gestation with progressiveexertional dyspnea and fatigue of several weeks duration. She alsoreported several recent syncopal episodes. Her first pregnancy wasuncomplicated, and she denied prior cardiopulmonary disease, illicitdrug use, or ingestion of anorexigens. On physical examination, hervital signs were as follows: BP, 90/60 mm Hg; heart rate, 105beats/min; respiratory rate, 20 breaths/min; and

Discussion

An early case series reported a 50% mortality rateassociated with pregnancy and PPH.1 A more recent accountnoted a 30% mortality rate2 and partly attributed thedecline in the mortality rate to earlier recognition, betterunderstanding of the pathophysiology of pulmonary hypertension, alongwith improvements in medical therapy and critical-care obstetrics. Recognition of the elevated maternal-fetal mortality rate has ledphysicians to recommend effective contraception and, in the event of

References (12)

There are more references available in the full text version of this article.

Cited by (92)

  • Managing Specific Cardiac Conditions During Pregnancy, Labor, and Delivery

    2022, Maternal Cardiac Care: A Guide to Managing Pregnant Women with Heart Disease
  • Pregnancy and pulmonary arterial hypertension: a case series and literature review

    2021, American Journal of Obstetrics and Gynecology MFM
    Citation Excerpt :

    The available parenteral prostaglandins include epoprostenol, treprostinil, and iloprost, which can be delivered via IV or inhaled formulations. IV epoprostenol remains the only PAH-targeted therapy with a mortality benefit,35 and there is growing evidence supporting its use in pregnancy.36–38 In a report of 3 patients with PAH who were started on IV epoprostenol, all survived without postpartum complications.39

  • Challenge of Pregnancy in Patients With Pre-Capillary Pulmonary Hypertension: Veno-Arterial Extracorporeal Membrane Oxygenation as an Innovative Support for Delivery

    2017, Journal of Cardiothoracic and Vascular Anesthesia
    Citation Excerpt :

    In the second patient, it was placed before the abdominal incision (preemptive). The authors’ limited experience suggests that successful pregnancy can be achieved in patients with advanced pre-capillary PH, after an individualized assessment and preparation of a plan by a multispecialist team with the help of modern circulatory assist devices.9,10 However, these results must be confirmed by a larger series before the general recommendation to avoid pregnancy in all patients with PH is reconsidered.

  • National Trends and In-Hospital Outcomes in Pregnant Women With Heart Disease in the United States

    2017, American Journal of Cardiology
    Citation Excerpt :

    We demonstrate that women with PH are at highest risk for maternal in-hospital mortality during the hospitalization for delivery. Improvements in PH-associated maternal death have occurred in the last 3 decades18,23–26; however, the peripartum and particularly the postpartum periods pose increased risk. It has been postulated that the mode of delivery and anesthesia, rapid changes in blood volume, and autotransfusion immediately after birth from the uterus are possible factors.

View all citing articles on Scopus
View full text