Analysis of Clinical Characteristics of 54 Dead Pregnant Patients With Pulmonary Hypertension.

Abstract

To analyze the clinical characteristics and potential pregnancy outcomes of deceased pregnant women with pulmonary hypertension, we conducted a retrospective analysis of clinical data from 54 cases of pregnant women with pulmonary hypertension at The Third Affiliated Hospital of Guangzhou Medical University from May 2009 to February 2022. The results demonstrated that (1) Among 54 deceased pregnant patients with pulmonary hypertension (PH), 44 patients belonged to type 1, and 3, 2, and 5 patients belonged to type 2, type 4, and type 5, respectively. In type 1, 33 cases were secondary to congenital heart disease, with ventricular septal defect being common. (2) All 54 patients were diagnosed with PAH during pregnancy or postpartum. NYHA cardiac function grade II (10 cases), Ⅲ (18 cases), Ⅳ (26 cases), heart disease pregnancy risk levels were all Ⅳ. (3) Of the 54 patients, 7 patients had no data on the time of death, and most of them (37 patients) died within 1 week postpartum. (4) These 9 patients with mild PAH death during pregnancy had lower ejection fraction, higher rates of postpartum hemorrhage, left heart failure, systemic failure, arrhythmia, gestational diabetes, and infection than those with moderate or severe PAH death during pregnancy. As a consequence, deaths in pregnancies complicated with PH were mostly caused by PAH crisis, total heart failure, multiple organ failure, Eisenmenger syndrome and maternal perinatal mortality was high. The primary causes of mortality in pregnant women with mild PH include heart failure, respiratory failure, and arrhythmia etc. Patients experiencing complications such as postpartum hemorrhage, left ventricular dysfunction, multiorgan failure, arrhythmia, gestational diabetes mellitus, and infection may have a poorer prognosis.