The multidisciplinary management of pulmonary arterial hypertension patients in pregnancy and postpartum: A case series

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Jasmine N. Edghill , Evan Wasserman , Mary Ashley Cain , Daniela R. Crousillat , Ricardo Restrepo-Jaramillo
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Abstract

Study objective

Pregnancy has been contraindicated in the setting of pulmonary arterial hypertension (PAH) due to elevated maternal and fetal risk. We review our center's successful experience with pregnant PAH patients in this case series.

Study design

This is a retrospective case series.

Participants

Six patients with PAH with seven pregnancies delivered at Tampa General Hospital from 2014 to 2024.

Interventions

All cases involved a multidisciplinary team to optimize antenatal and intrapartum management. The REVEAL 2.0 risk assessment tool also guided treatment planning by determining risk status.

Results

Almost all of the patients in our study were diagnosed with PAH by right heart catheterization at our institution pre- or during pregnancy. All patients were either on a phosphodiesterase inhibitor or prostacyclin during their pregnancies. One mother was admitted at 34 weeks 1 day for decompensated heart failure without prior PAH treatment. All patients with outpatient follow-up had serial 6 min walk distances, brain natriuretic peptide levels, echocardiograms, and right heart catheterizations, and were able to achieve a low risk REVEAL 2.0 score during the pregnancy. All patient cases delivered via cesarean section with shared decision making and 5/7 cases were preterm. There was a 100 % maternal and fetal survival rate in our case series within the 1 year postpartum period.

Conclusion

Although pregnancy is a relative contraindication in patients with PAH, our case series demonstrates that a multidisciplinary approach to care at a specialized center for pulmonary vascular disease with close, personalized ante- and postnatal management can result in successful outcomes.
妊娠和产后肺动脉高压患者的多学科管理:一个病例系列
研究目的肺动脉高压(PAH)由于母婴风险增高,禁止妊娠。在本病例系列中,我们回顾本中心治疗妊娠多环芳烃患者的成功经验。研究设计:这是一个回顾性的病例系列。参与者:2014年至2024年在坦帕总医院分娩的6例7次妊娠的PAH患者。干预措施:所有病例均由一个多学科小组进行,以优化产前和产时管理。REVEAL 2.0风险评估工具也通过确定风险状态来指导治疗计划。结果在我们的研究中,几乎所有的患者都是在怀孕前或怀孕期间通过右心导管诊断为PAH的。所有患者在怀孕期间都服用磷酸二酯酶抑制剂或前列环素。一位母亲在34周1天因失代偿性心力衰竭入院,此前未接受PAH治疗。所有门诊随访的患者均有连续的6分钟步行距离、脑利钠肽水平、超声心动图和右心导管检查,并且在妊娠期间能够达到低风险的REVEAL 2.0评分。所有患者均为共同决策剖宫产,5/7为早产。在我们的病例系列中,在产后1年内,母胎存活率为100%。结论:尽管妊娠是PAH患者的相对禁忌症,但我们的病例系列表明,在肺血管疾病的专业中心进行多学科的护理,并进行密切、个性化的产前和产后管理,可以取得成功的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.60
自引率
0.00%
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审稿时长
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