Outcome of pulmonary hypertension in pregnancy in contemporary era: A case-based narrative review

Abstract

A 35-year-old female presented to us with a history of exertional dyspnea from the last 20 years and low oxygen saturation noticed from last 1 month during her COVID-19-related illness. The patient did not seek medical attention over these years as the degree of limitation of physical activity was modest. She had a bad obstetric history: five second trimester pregnancy losses and one early neonatal death. Her symptoms were worse during pregnancy and improved thereafter. Physical examination was notable of cyanosis and features of pulmonary hypertension (PH). Echocardiography was suggestive of double outlet right ventricle, large subaortic ventricular septal defect with bidirectional shunt, and severe PH. This case highlights a variable clinical outcome of Eisenmenger syndrome in pregnancy. We did a literature review for studies reporting the outcomes of PH in pregnancy. The overall mortality rates seem to have declined dramatically from as high as 56% reported in studies in the 1990s to < 5% in more contemporary studies. The common adverse obstetric outcomes include prematurity and growth restriction.