Researchers reported 7 out of 9 successful pregnancies and deliveries in a cohort of women with pulmonary arterial hypertension (PAH), as published in the Australian and New Zealand Journal of Obstetrics and Gynaecology. They noted that regional neuraxial anesthesia facilitated the delivery process and improved the patient experience.
“The aim of this retrospective review was to examine maternal and neonatal outcomes in women with PAH between 2005 and 2020 and identify obstetric, cardiac and anesthetic characteristics,” the authors wrote. “This will assist in improving management of these high-risk patients and inform education and counseling.”
The research team followed a cohort of 6 women with PAH and their 9 pregnancies over a period of 15 years at a single center in Sydney, Australia. They collected information on demographics, medical, obstetric, and anesthetic data, as well as Apgar score and weight in the newborns.
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Given the complexity of PAH during pregnancy and its accompanying mortality risk, all of the women were counseled prior to and during the first trimester, and 2 pregnancies were electively aborted. Two women were diagnosed with PAH after 36 weeks of gestation, and 5 pregnancies in women with known PAH were continued.
All the women who continued their pregnancy delivered successfully, 70% vaginally and all with regional anesthesia. The authors conclude that although PAH continues to be a disease with high morbidity and mortality, particularly during pregnancy, with close monitoring and appropriate care it is possible to have a successful term birth.
They recommend shared decision-making and ongoing communication with health care providers prior to and during pregnancy to optimize the outcomes of these patients.
Boyers S, Nayyar R, Melov S, et al. A case series describing the multidisciplinary management of pulmonary arterial hypertension in pregnancy: time for optimism. Aust N Z J Obstet Gynaecol. Published online June 14, 2022. doi:10.1111/ajo.13557