Login Register Cart 0
Generic placeholder image

Current Respiratory Medicine Reviews

Editor-in-Chief

ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Management of Pulmonary Hypertension during Pregnancy

Author(s): Yuri Matusov*, Adnan Khan, Candace Levian, John Ozimek and Victor F. Tapson

Volume 20, Issue 3, 2024

Published on: 17 January, 2024

Page: [272 - 290] Pages: 19

DOI: 10.2174/011573398X267692231106065628

Price: $65

Abstract

Pregnancy in patients with pulmonary arterial hypertension (PAH) is a high-risk condition associated with high morbidity and mortality. Patients with severe PAH are often advised against pregnancy. Still, those patients who pursue pregnancy require a dedicated and multidisciplinary approach since the progression of fetal growth will accompany significant hemodynamic changes, which can be challenging for patients with a poorly functioning right ventricle. In this article, we describe the approach to the unique cardiovascular, respiratory, hematologic, and social challenges that pregnant patients with PAH face throughout pregnancy. We discuss the impact of these physiologic changes on diagnostic studies commonly used in PAH and how to incorporate diagnostic data in making the diagnosis and risk stratifying pregnant patients with PAH. The pharmacologic challenges of pulmonary vasodilators in pregnancy are discussed as well. Pregnant patients with PAH are at particularly high risk of mortality around the time of delivery, and we discuss the multidisciplinary approach to the management of these patients, including the use of anesthesia, inotropic support, type of delivery, and postpartum care, providing clinicians with a practical approach to the management of this difficult condition.

« Previous
[1]
Pijuan-Domènech A, Galian L, Goya M, et al. Cardiac complications during pregnancy are better predicted with the modified WHO risk score. Int J Cardiol 2015; 195: 149-54.
[http://dx.doi.org/10.1016/j.ijcard.2015.05.076] [PMID: 26043149]
[2]
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39(34): 3165-241.
[http://dx.doi.org/10.1093/eurheartj/ehy340] [PMID: 30165544]
[3]
Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43(38): 3618-731.
[http://dx.doi.org/10.1093/eurheartj/ehac237] [PMID: 36017548]
[4]
Lima FV, Yang J, Xu J, Stergiopoulos K. National trends and in-hospital outcomes in pregnant women with heart disease in the United States. Am J Cardiol 2017; 119(10): 1694-700.
[http://dx.doi.org/10.1016/j.amjcard.2017.02.003] [PMID: 28343597]
[5]
Sliwa K, van Hagen IM, Budts W, et al. Pulmonary hypertension and pregnancy outcomes: Data from the registry of pregnancy and cardiac disease (ROPAC) of the european society of cardiology. Eur J Heart Fail 2016; 18(9): 1119-28.
[http://dx.doi.org/10.1002/ejhf.594] [PMID: 27384461]
[6]
Low TT, Guron N, Ducas R, et al. Pulmonary arterial hypertension in pregnancy : A systematic review of outcomes in the modern era. Pulm Circ 2021; 11(2): 1-9.
[http://dx.doi.org/10.1177/20458940211013671] [PMID: 34104423]
[7]
Drenthen W, Pieper PG, Roos-Hesselink JW, et al. Outcome of pregnancy in women with congenital heart disease: A literature review. J Am Coll Cardiol 2007; 49(24): 2303-11.
[http://dx.doi.org/10.1016/j.jacc.2007.03.027] [PMID: 17572244]
[8]
Arvanitaki A, Gatzoulis MA, Opotowsky AR, et al. Eisenmenger syndrome. J Am Coll Cardiol 2022; 79(12): 1183-98.
[http://dx.doi.org/10.1016/j.jacc.2022.01.022] [PMID: 35331414]
[9]
Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: A systematic overview from 1978 through 1996. J Am Coll Cardiol 1998; 31(7): 1650-7.
[http://dx.doi.org/10.1016/S0735-1097(98)00162-4] [PMID: 9626847]
[10]
Bédard E, Dimopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J 2008; 30(3): 256-65.
[http://dx.doi.org/10.1093/eurheartj/ehn597] [PMID: 19147605]
[11]
Jaïs X, Olsson KM, Barbera JA, et al. Pregnancy outcomes in pulmonary arterial hypertension in the modern management era. Eur Respir J 2012; 40(4): 881-5.
[http://dx.doi.org/10.1183/09031936.00141211] [PMID: 22282544]
[12]
Katsuragi S, Yamanaka K, Neki R, et al. Maternal outcome in pregnancy complicated with pulmonary arterial hypertension. Circ J 2012; 76(9): 2249-54.
[http://dx.doi.org/10.1253/circj.CJ-12-0235] [PMID: 22785004]
[13]
Luo J, Shi H, Xu L, Su W, Li J. Pregnancy outcomes in patients with pulmonary arterial hypertension. Medicine 2020; 99(23): e20285.
[http://dx.doi.org/10.1097/MD.0000000000020285] [PMID: 32501975]
[14]
Chakravarty EF, Khanna D, Chung L. Pregnancy outcomes in systemic sclerosis, primary pulmonary hypertension, and sickle cell disease. Obstet Gynecol 2008; 111(4): 927-34.
[http://dx.doi.org/10.1097/01.AOG.0000308710.86880.a6] [PMID: 18378753]
[15]
Kamp JC, von Kaisenberg C, Greve S, et al. Pregnancy in pulmonary arterial hypertension: Midterm outcomes of mothers and offspring. J Heart Lung Transplant 2021; 40(3): 229-33.
[http://dx.doi.org/10.1016/j.healun.2020.12.002] [PMID: 33376037]
[16]
LoMauro A, Aliverti A. Respiratory physiology of pregnancy. Breathe 2015; 11(4): 297-301.
[http://dx.doi.org/10.1183/20734735.008615] [PMID: 27066123]
[17]
Jensen D, Webb KA, Davies GAL, O’Donnell DE. Mechanical ventilatory constraints during incremental cycle exercise in human pregnancy: Implications for respiratory sensation. J Physiol 2008; 586(19): 4735-50.
[http://dx.doi.org/10.1113/jphysiol.2008.158154] [PMID: 18687714]
[18]
McAuliffe F, Kametas N, Costello J, Rafferty GF, Greenough A, Nicolaides K. Respiratory function in singleton and twin pregnancy. BJOG 2002; 109(7): 765-9.
[http://dx.doi.org/10.1111/j.1471-0528.2002.01515.x] [PMID: 12135212]
[19]
Cugell DW, Frank NR, Gaensler EA, Badger TL. Pulmonary function in pregnancy. I. Serial observations in normal women. Am Rev Tuberc 1953; 67(5): 568-97.
[PMID: 13040686]
[20]
Nørregaard O, Schultz P, Østergaard A, Dahl R. Lung function and postural changes during pregnancy. Respir Med 1989; 83(6): 467-70.
[http://dx.doi.org/10.1016/S0954-6111(89)80127-1] [PMID: 2623214]
[21]
Goldsmith LT, Weiss G, Steinetz BG. Relaxin and its role in pregnancy. Endocrinol Metab Clin North Am 1995; 24(1): 171-86.
[http://dx.doi.org/10.1016/S0889-8529(18)30058-6] [PMID: 7781625]
[22]
Contreras G, GutiéRrez M, Beroíza T, et al. Ventilatory drive and respiratory muscle function in pregnancy. Am Rev Respir Dis 1991; 144(4): 837-41.
[http://dx.doi.org/10.1164/ajrccm/144.4.837] [PMID: 1928958]
[23]
Gilroy RJ, Mangura BT, Lavietes MH. Rib cage and abdominal volume displacements during breathing in pregnancy. Am Rev Respir Dis 1988; 137(3): 668-72.
[http://dx.doi.org/10.1164/ajrccm/137.3.668] [PMID: 3345045]
[24]
McCormack MC, Wise RA. Respiratory physiology in pregnancy.Pulmonary Problems in Pregnancy. Humana Press 2009.
[http://dx.doi.org/10.1007/978-1-59745-445-2_2]
[25]
Lyons HA, Antonio R. The sensitivity of the respiratory center in pregnancy and after administration of progesterone. Trans Assoc Am Physicians 1959; 72: 173-80.
[26]
Jensen D, Wolfe LA, Slatkovska L, Webb KA, Davies GAL, O’Donnell DE. Effects of human pregnancy on the ventilatory chemoreflex response to carbon dioxide. Am J Physiol Regul Integr Comp Physiol 2005; 288(5): R1369-75.
[http://dx.doi.org/10.1152/ajpregu.00862.2004] [PMID: 15677521]
[27]
Prowse CM, Gaensler EA. Respiratory and acid-base changes during pregnancy. Anesthesiology 1965; 26(4): 381-92.
[http://dx.doi.org/10.1097/00000542-196507000-00003] [PMID: 14313450]
[28]
Templeton A, Kelman GR. Maternal blood-gases, ( P A O2 — P a O2 ), physiological shunt and v d/ v t in normal pregnancy. Br J Anaesth 1976; 48(10): 1001-4.
[http://dx.doi.org/10.1093/bja/48.10.1001] [PMID: 10937]
[29]
Weinberger SE, Weiss ST, Cohen WR, Weiss JW, Johnson TS. Pregnancy and the lung. Am Rev Respir Dis 1980; 121(3): 559-81.
[http://dx.doi.org/10.1164/arrd.1980.121.3.559] [PMID: 6998334]
[30]
Milne JA, Howie AD, Pack AI. Dyspnoea during normal pregnancy. BJOG 1978; 85(4): 260-3.
[http://dx.doi.org/10.1111/j.1471-0528.1978.tb10497.x] [PMID: 638094]
[31]
Archer GW Jr, Marx GF. Arterial oxygen tension during apnoea in parturient women. Br J Anaesth 1974; 46(5): 358-60.
[http://dx.doi.org/10.1093/bja/46.5.358] [PMID: 4157184]
[32]
Arendt KW, Lindley KJ. Obstetric anesthesia management of the patient with cardiac disease. Int J Obstet Anesth 2019; 37: 73-85.
[http://dx.doi.org/10.1016/j.ijoa.2018.09.011] [PMID: 30415799]
[33]
Lapinsky SE, Tram C, Mehta S, Maxwell CV. Restrictive lung disease in pregnancy. Chest 2014; 145(2): 394-8.
[http://dx.doi.org/10.1378/chest.13-0587] [PMID: 24493511]
[34]
Chen YH, Kang JH, Lin CC, Wang IT, Keller JJ, Lin HC. Obstructive sleep apnea and the risk of adverse pregnancy outcomes. Am J Obstet Gynecol 2012; 206(2): 136.e1-5.
[http://dx.doi.org/10.1016/j.ajog.2011.09.006] [PMID: 22000892]
[35]
Kapsimalis F, Kryger M. Obstructive sleep apnea in pregnancy. Sleep Med Clin 2007; 2(4): 603-13.
[http://dx.doi.org/10.1016/j.jsmc.2007.07.002]
[36]
Boutonnet M, Faitot V, Katz A, Salomon L, Keita H. Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted? Br J Anaesth 2010; 104(1): 67-70.
[http://dx.doi.org/10.1093/bja/aep356] [PMID: 20007793]
[37]
Mehta LS, Warnes CA, Bradley E, et al. Cardiovascular considerations in caring for pregnant patients: A scientific statement from the american heart association. Circulation 2020; 141(23): e884-903.
[http://dx.doi.org/10.1161/CIR.0000000000000772] [PMID: 32362133]
[38]
Mahendru AA, Everett TR, Wilkinson IB, Lees CC, McEniery CM. A longitudinal study of maternal cardiovascular function from preconception to the postpartum period. J Hypertens 2014; 32(4): 849-56.
[http://dx.doi.org/10.1097/HJH.0000000000000090] [PMID: 24406777]
[39]
Vinayagam D, Thilaganathan B, Stirrup O, Mantovani E, Khalil A. Maternal hemodynamics in normal pregnancy: Reference ranges and role of maternal characteristics. Ultrasound Obstet Gynecol 2018; 51(5): 665-71.
[http://dx.doi.org/10.1002/uog.17504] [PMID: 28437601]
[40]
O’ Callaghan KM, Hennessy Á, Malvisi L, Kiely M. Central haemodynamics in normal pregnancy. J Hypertens 2018; 36(10): 2102-8.
[http://dx.doi.org/10.1097/HJH.0000000000001768] [PMID: 30044310]
[41]
Barron WM, Mujais SK, Zinaman M, Bravo EL, Lindheimer MD. Plasma catecholamine responses to physiologic stimuli in normal human pregnancy. Am J Obstet Gynecol 1986; 154(1): 80-4.
[http://dx.doi.org/10.1016/0002-9378(86)90397-2] [PMID: 3511708]
[42]
Roberts JM, Insel PA, Goldfien A. Regulation of myometrial adrenoreceptors and adrenergic response by sex steroids. Mol Pharmacol 1981; 20(1): 52-8.
[PMID: 6270537]
[43]
Knock GA, Poston L. Bradykinin-mediated relaxation of isolated maternal resistance arteries in normal pregnancy and preeclampsia. Am J Obstet Gynecol 1996; 175(6): 1668-74.
[http://dx.doi.org/10.1016/S0002-9378(96)70123-0] [PMID: 8987958]
[44]
Curran-Everett D, Morris KG Jr, Moore LG. Regional circulatory contributions to increased systemic vascular conductance of pregnancy. Am J Physiol 1991; 261(6 Pt 2): H1842-7.
[PMID: 1750538]
[45]
Sharma R, Kumar A, Aneja GK. Serial changes in pulmonary hemodynamics during pregnancy: A non-invasive study using doppler echocardiography. Cardiol Res 2016; 7(1): 25-31.
[http://dx.doi.org/10.14740/cr448w] [PMID: 28197265]
[46]
Singh I, Horn E, Haythe J. Pulmonary hypertension in pregnancy. Clin Chest Med 2021; 42(1): 91-9.
[http://dx.doi.org/10.1016/j.ccm.2020.10.006] [PMID: 33541621]
[47]
Vonk Noordegraaf A, Chin KM, Haddad F, et al. Pathophysiology of the right ventricle and of the pulmonary circulation in pulmonary hypertension: An update. Eur Respir J 2019; 53(1): 1801900.
[http://dx.doi.org/10.1183/13993003.01900-2018] [PMID: 30545976]
[48]
Ueland K. Maternal cardiovascular dynamics. Am J Obstet Gynecol 1976; 126(6): 671-7.
[http://dx.doi.org/10.1016/0002-9378(76)90517-2] [PMID: 984141]
[49]
Hunter S, Robson SC. Adaptation of the maternal heart in pregnancy. Heart 1992; 68(12): 540-3.
[http://dx.doi.org/10.1136/hrt.68.12.540] [PMID: 1467047]
[50]
Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation 2014; 130(12): 1003-8.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.114.009029] [PMID: 25223771]
[51]
Nishimura RA, Tajik AJ. The Valsalva maneuver-3 centuries later. Mayo Clin Proc 2004; 79(4): 577-8.
[http://dx.doi.org/10.4065/79.4.577] [PMID: 15065629]
[52]
Kampman MAM, Valente MAE, van Melle JP, et al. Cardiac adaption during pregnancy in women with congenital heart disease and healthy women. Heart 2016; 102(16): 1302-8.
[http://dx.doi.org/10.1136/heartjnl-2015-308946] [PMID: 27048772]
[53]
Bernstein IM, Ziegler W, Badger GJ. Plasma volume expansion in early pregnancy. Obstet Gynecol 2001; 97(5 Pt 1): 669-72.
[PMID: 11339913]
[54]
Aguree S, Gernand AD. Plasma volume expansion across healthy pregnancy: A systematic review and meta-analysis of longitudinal studies. BMC Pregnancy Childbirth 2019; 19(1): 508.
[http://dx.doi.org/10.1186/s12884-019-2619-6] [PMID: 31856759]
[55]
West CA, Sasser JM, Baylis C. The enigma of continual plasma volume expansion in pregnancy: critical role of the renin-angiotensin-aldosterone system. Am J Physiol Renal Physiol 2016; 311(6): F1125-34.
[http://dx.doi.org/10.1152/ajprenal.00129.2016] [PMID: 27707703]
[56]
Sifakis S, Pharmakides G. Anemia in pregnancy. Ann N Y Acad Sci 2000; 900(1): 125-36.
[http://dx.doi.org/10.1111/j.1749-6632.2000.tb06223.x] [PMID: 10818399]
[57]
Breymann C. Iron deficiency anemia in pregnancy. Semin Hematol 2015; 52(4): 339-47.
[http://dx.doi.org/10.1053/j.seminhematol.2015.07.003] [PMID: 26404445]
[58]
Frise MC, Cheng HY, Nickol AH, et al. Clinical iron deficiency disturbs normal human responses to hypoxia. J Clin Invest 2016; 126(6): 2139-50.
[http://dx.doi.org/10.1172/JCI85715] [PMID: 27140401]
[59]
Ruiter G, Lankhorst S, Boonstra A, et al. Iron deficiency is common in idiopathic pulmonary arterial hypertension. Eur Respir J 2011; 37(6): 1386-91.
[http://dx.doi.org/10.1183/09031936.00100510] [PMID: 20884742]
[60]
Ruiter G, Manders E, Happé CM, et al. Intravenous iron therapy in patients with idiopathic pulmonary arterial hypertension and iron deficiency. Pulm Circ 2015; 5(3): 466-72.
[http://dx.doi.org/10.1086/682217] [PMID: 26401247]
[61]
Smith TG, Talbot NP, Privat C, et al. Effects of iron supplementation and depletion on hypoxic pulmonary hypertension: Two randomized controlled trials. JAMA 2009; 302(13): 1444-50.
[http://dx.doi.org/10.1001/jama.2009.1404] [PMID: 19809026]
[62]
Ataga KI, Moore CG, Jones S, et al. Pulmonary hypertension in patients with sickle cell disease: A longitudinal study. Br J Haematol 2006; 134(1): 109-15.
[http://dx.doi.org/10.1111/j.1365-2141.2006.06110.x] [PMID: 16803576]
[63]
Gladwin MT, Sachdev V, Jison ML, et al. Pulmonary hypertension as a risk factor for death in patients with sickle cell disease. N Engl J Med 2004; 350(9): 886-95.
[http://dx.doi.org/10.1056/NEJMoa035477] [PMID: 14985486]
[64]
Fraidenburg DR, Machado RF. Pulmonary hypertension associated with thalassemia syndromes. Ann N Y Acad Sci 2016; 1368(1): 127-39.
[http://dx.doi.org/10.1111/nyas.13037] [PMID: 27008311]
[65]
Gynecologists ACoOa. Hemoglobinopathies in pregnancy. Update to ACOG Practice Bulletin No. 78.: ACOG Clinical 2022.
[66]
Liem RI, Lanzkron S, D Coates T, et al. American society of hematology 2019 guidelines for sickle cell disease: Cardiopulmonary and kidney disease. Blood Adv 2019; 3(23): 3867-97.
[http://dx.doi.org/10.1182/bloodadvances.2019000916] [PMID: 31794601]
[67]
Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ III. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: A 30-year population-based study. Ann Intern Med 2005; 143(10): 697-706.
[http://dx.doi.org/10.7326/0003-4819-143-10-200511150-00006] [PMID: 16287790]
[68]
James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors, and mortality. Am J Obstet Gynecol 2006; 194(5): 1311-5.
[http://dx.doi.org/10.1016/j.ajog.2005.11.008] [PMID: 16647915]
[69]
Meng K, Hu X, Peng X, Zhang Z. Incidence of venous thromboembolism during pregnancy and the puerperium: A systematic review and meta-analysis. J Matern Fetal Neonatal Med 2015; 28(3): 245-53.
[http://dx.doi.org/10.3109/14767058.2014.913130] [PMID: 24716782]
[70]
Hellgren M. Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost 2003; 29(2): 125-30.
[http://dx.doi.org/10.1055/s-2003-38897] [PMID: 12709915]
[71]
Faught W, Garner P, Jones G, Ivey B. Changes in protein C and protein S levels in normal pregnancy. Am J Obstet Gynecol 1995; 172(1): 147-50.
[http://dx.doi.org/10.1016/0002-9378(95)90104-3] [PMID: 7847526]
[72]
Andersson T, Lorentzen B, Høgdahl H, Clausen T, Mowinckel MC, Abildgaard U. Thrombin-inhibitor complexes in the blood during and after delivery. Thromb Res 1996; 82(2): 109-17.
[http://dx.doi.org/10.1016/0049-3848(96)00057-6] [PMID: 9163064]
[73]
Kjellberg U, Andersson NE, Rosén S, Tengborn L, Hellgren M. APC resistance and other haemostatic variables during pregnancy and puerperium. Thromb Haemost 1999; 81(4): 527-31.
[http://dx.doi.org/10.1055/s-0037-1614518] [PMID: 10235433]
[74]
Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol 1997; 79(8): 1061-4.
[http://dx.doi.org/10.1016/S0002-9149(97)00047-7] [PMID: 9114764]
[75]
Rodriguez A, Bohlin G, Lindmark G. Symptoms across pregnancy in relation to psychosocial and biomedical factors. Acta Obstet Gynecol Scand 2001; 80(3): 213-23.
[http://dx.doi.org/10.1034/j.1600-0412.2001.080003213.x] [PMID: 11207486]
[76]
Davison JM. Edema in pregnancy. Kidney Int Suppl 1997; 59: S90-6.
[PMID: 9185112]
[77]
Davies GAL, Herbert WNP. Assessment and management of cardiac disease in pregnancy. J Obstet Gynaecol Can 2007; 29(4): 331-6.
[http://dx.doi.org/10.1016/S1701-2163(16)32432-X] [PMID: 17475126]
[78]
Cutforth R, MacDonald CB. Heart sounds and murmurs in pregnancy. Am Heart J 1966; 71(6): 741-7.
[http://dx.doi.org/10.1016/0002-8703(66)90594-1] [PMID: 5945138]
[79]
Benza RL, Gomberg-Maitland M, Elliott CG, et al. Predicting survival in patients with pulmonary arterial hypertension. Chest 2019; 156(2): 323-37.
[http://dx.doi.org/10.1016/j.chest.2019.02.004] [PMID: 30772387]
[80]
Minhas AS, Rooney MR, Fang M, Zhang S, Ndumele CE, Tang O, et al. Prevalence and correlates of elevated NT-proBNP in pregnant women in the general U.S. Population. JACC: Adv 2023; 2(2)
[81]
Resnik JL, Hong C, Resnik R, et al. Evaluation of B-type natriuretic peptide (BNP) levels in normal and preeclamptic women. Am J Obstet Gynecol 2005; 193(2): 450-4.
[http://dx.doi.org/10.1016/j.ajog.2004.12.006] [PMID: 16098869]
[82]
Wiles K, Bramham K, Seed PT, Nelson-Piercy C, Lightstone L, Chappell LC. Serum creatinine in pregnancy: A systematic review. Kidney Int Rep 2019; 4(3): 408-19.
[http://dx.doi.org/10.1016/j.ekir.2018.10.015] [PMID: 30899868]
[83]
Wiles K, Chappell L, Clark K, et al. Clinical practice guideline on pregnancy and renal disease. BMC Nephrol 2019; 20(1): 401.
[http://dx.doi.org/10.1186/s12882-019-1560-2] [PMID: 31672135]
[84]
Robertson L, Wu O, Langhorne P, et al. Thrombophilia in pregnancy: A systematic review. Br J Haematol 2006; 132(2): 171-96.
[http://dx.doi.org/10.1111/j.1365-2141.2005.05847.x] [PMID: 16398652]
[85]
Eichinger S. D-dimer testing in pregnancy. Pathophysiol Haemost Thromb 2003; 33(5-6): 327-9.
[http://dx.doi.org/10.1159/000083822] [PMID: 15692237]
[86]
Kline JA, Williams GW, Hernandez-Nino J. D-dimer concentrations in normal pregnancy: New diagnostic thresholds are needed. Clin Chem 2005; 51(5): 825-9.
[http://dx.doi.org/10.1373/clinchem.2004.044883] [PMID: 15764641]
[87]
van der Pol LM, Tromeur C, Bistervels IM, et al. Pregnancy : Adapted years algorithm for diagnosis of suspected pulmonary embolism. N Engl J Med 2019; 380(12): 1139-49.
[http://dx.doi.org/10.1056/NEJMoa1813865] [PMID: 30893534]
[88]
Madras V, Challa N. Electrocardiographic variations during three trimesters of normal pregnancy. Int J Res Med Sci 2015; 2218-22.
[http://dx.doi.org/10.18203/2320-6012.ijrms20150605]
[89]
Tonelli AR, Baumgartner M, Alkukhun L, Minai OA, Dweik RA. Electrocardiography at diagnosis and close to the time of death in pulmonary arterial hypertension. Ann Noninvasive Electrocardiol 2014; 19(3): 258-65.
[http://dx.doi.org/10.1111/anec.12125] [PMID: 24372670]
[90]
Campos O, Andrade JL, Bocanegra J, et al. Physiologic multivalvular regurgitation during pregnancy: A longitudinal Doppler echocardiographic study. Int J Cardiol 1993; 40(3): 265-72.
[http://dx.doi.org/10.1016/0167-5273(93)90010-E] [PMID: 8225661]
[91]
Penning S, Robinson KD, Major CA, Garite TJ. A comparison of echocardiography and pulmonary artery catheterization for evaluation of pulmonary artery pressures in pregnant patients with suspected pulmonary hypertension. Am J Obstet Gynecol 2001; 184(7): 1568-70.
[http://dx.doi.org/10.1067/mob.2001.114857] [PMID: 11408882]
[92]
Wylie BJ, Epps KC, Gaddipati S, Waksmonski CA. Correlation of transthoracic echocardiography and right heart catheterization in pregnancy. J Perinat Med 2007; 35(6): 497-502.
[http://dx.doi.org/10.1515/JPM.2007.133] [PMID: 18052837]
[93]
Lum M, Tsiouris AJ. MRI safety considerations during pregnancy. Clin Imaging 2020; 62: 69-75.
[http://dx.doi.org/10.1016/j.clinimag.2020.02.007] [PMID: 32109683]
[94]
Datta D, Normandin E, ZuWallack R. Cardiopulmonary exercise testing in the assessment of exertional dyspnea. Ann Thorac Med 2015; 10(2): 77-86.
[http://dx.doi.org/10.4103/1817-1737.151438] [PMID: 25829957]
[95]
Mojoli F, Zanierato M, Campana C, Braschi A. Inhaled nitric oxide test in a pregnant patient with severe pulmonary hypertension. Anaesthesia 2006; 61(9): 912.
[http://dx.doi.org/10.1111/j.1365-2044.2006.04769.x] [PMID: 16922775]
[96]
Canobbio MM, Warnes CA, Aboulhosn J, et al. Management of pregnancy in patients with complex congenital heart disease: A scientific statement for healthcare professionals from the american heart association. Circulation 2017; 135(8): e50-87.
[http://dx.doi.org/10.1161/CIR.0000000000000458] [PMID: 28082385]
[97]
Bonnin M, Mercier FJ, Sitbon O, et al. Severe pulmonary hypertension during pregnancy: Mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiology 2005; 102(6): 1133-7.
[http://dx.doi.org/10.1097/00000542-200506000-00012] [PMID: 15915025]
[98]
Bourgioti C, Konidari M, Gourtsoyianni S, Moulopoulos LA. Imaging during pregnancy: What the radiologist needs to know. Diagn Interv Imaging 2021; 102(10): 593-603.
[http://dx.doi.org/10.1016/j.diii.2021.05.003] [PMID: 34059484]
[99]
ICRP. Pregnancy and Medical Radiation. ICRP Publication 84. Ann ICRP 2000; 30.
[100]
Gjelsteen AC, Ching BH, Meyermann MW, et al. CT, MRI, PET, PET/CT, and ultrasound in the evaluation of obstetric and gynecologic patients. Surg Clin North Am 2008; 88(2): 361-390, vii.
[http://dx.doi.org/10.1016/j.suc.2008.01.005] [PMID: 18381118]
[101]
#299. ACO. Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104.
[102]
Mayo JR, Jackson SA, Müller NL. High-resolution CT of the chest: Radiation dose. AJR Am J Roentgenol 1993; 160(3): 479-81.
[http://dx.doi.org/10.2214/ajr.160.3.8430539] [PMID: 8430539]
[103]
Corbach N, Berlier C, Lichtblau M, et al. Favorable pregnancy outcomes in women with well-controlled pulmonary arterial hypertension. Front Med 2021; 8: 689764.
[http://dx.doi.org/10.3389/fmed.2021.689764] [PMID: 34291063]
[104]
Silversides CK, Grewal J, Mason J, et al. Pregnancy outcomes in women with heart disease. J Am Coll Cardiol 2018; 71(21): 2419-30.
[http://dx.doi.org/10.1016/j.jacc.2018.02.076] [PMID: 29793631]
[105]
Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104(5): 515-21.
[http://dx.doi.org/10.1161/hc3001.093437] [PMID: 11479246]
[106]
Ruys TPE, Roos-Hesselink JW, Hall R, et al. Heart failure in pregnant women with cardiac disease: Data from the ROPAC. Heart 2014; 100(3): 231-8.
[http://dx.doi.org/10.1136/heartjnl-2013-304888] [PMID: 24293523]
[107]
Hemnes AR, Kiely DG, Cockrill BA, et al. Statement on pregnancy in pulmonary hypertension from the pulmonary vascular research institute. Pulm Circ 2015; 5(3): 435-65.
[http://dx.doi.org/10.1086/682230] [PMID: 26401246]
[108]
Subbaiah M, Kumar S, Roy KK, Sharma JB, Singh N. Pregnancy outcome in women with pulmonary arterial hypertension: single- center experience from India. Arch Gynecol Obstet 2013; 288(2): 305-9.
[http://dx.doi.org/10.1007/s00404-013-2761-8] [PMID: 23440407]
[109]
Pieper PG, Lameijer H, Hoendermis ES. Pregnancy and pulmonary hypertension. Best Pract Res Clin Obstet Gynaecol 2014; 28(4): 579-91.
[http://dx.doi.org/10.1016/j.bpobgyn.2014.03.003] [PMID: 24685319]
[110]
Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016; 65(3): 1-103.
[http://dx.doi.org/10.15585/mmwr.rr6503a1] [PMID: 27467196]
[111]
Hill W, Holy R, Traiger G. EXPRESS: Intimacy, contraception, and pregnancy prevention in patients with pulmonary arterial hypertension: Are we counseling our patients? Pulm Circ 2018; 10(4): 2045894018785259.
[PMID: 29893615]
[112]
Lindley KJ, Madden T, Cahill AG, Ludbrook PA, Billadello JJ. Contraceptive use and unintended pregnancy in women with congenital heart disease. Obstet Gynecol 2015; 126(2): 363-9.
[http://dx.doi.org/10.1097/AOG.0000000000000911] [PMID: 26241427]
[113]
Krishnan S, Fricke EM, Cordoba M, Chalifoux LA, Girgis RE. Pulmonary hypertension complicating pregnancy. Curr Pulmonol Rep 2021; 10(2): 71-83.
[http://dx.doi.org/10.1007/s13665-021-00275-1]
[114]
Guiahi M, Davis A. First-trimester abortion in women with medical conditions. Contraception 2012; 86(6): 622-30.
[http://dx.doi.org/10.1016/j.contraception.2012.09.001] [PMID: 23039921]
[115]
Daar J, Benward J, Collins L, et al. Consideration of the gestational carrier: An Ethics Committee opinion. Fertil Steril 2018; 110(6): 1017-21.
[http://dx.doi.org/10.1016/j.fertnstert.2018.08.029] [PMID: 30396538]
[116]
Clennon EK, Pare E, Amato P, Caughey AB. Use of gestational surrogates for women with Eisenmenger syndrome: A cost-effectiveness analysis. J Matern Fetal Neonatal Med 2021; 34(4): 526-31.
[http://dx.doi.org/10.1080/14767058.2019.1610734] [PMID: 31006283]
[117]
Metzler E, Ginsburg E, Tsen LC. Use of assisted reproductive technologies and anesthesia in a patient with primary pulmonary hypertension. Fertil Steril 2004; 81(6): 1684-7.
[http://dx.doi.org/10.1016/j.fertnstert.2003.12.021] [PMID: 15193496]
[118]
Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2): e691S-736S.
[119]
Kiely DG, Condliffe R, Webster V, Mills GH, Wrench I, Gandhi SV, et al. Improved survival in pregnancy and pulmonary hypertension using a multiprofessional approach. BJOG Int J Obstet Gynaecol 2010; 117.
[120]
Sitbon O, Humbert M, Jaïs X, et al. Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension. Circulation 2005; 111(23): 3105-11.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.104.488486] [PMID: 15939821]
[121]
Montani D, Savale L, Natali D, et al. Long-term response to calcium-channel blockers in non-idiopathic pulmonary arterial hypertension. Eur Heart J 2010; 31(15): 1898-907.
[http://dx.doi.org/10.1093/eurheartj/ehq170] [PMID: 20543192]
[122]
Malha L, August P. Safety of antihypertensive medications in pregnancy: Living with uncertainty. J Am Heart Assoc 2019; 8(15): e013495.
[http://dx.doi.org/10.1161/JAHA.119.013495] [PMID: 31345085]
[123]
Dunn L, Greer R, Flenady V, Kumar S. Sildenafil in pregnancy: A systematic review of maternal tolerance and obstetric and perinatal outcomes. Fetal Diagn Ther 2017; 41(2): 81-8.
[http://dx.doi.org/10.1159/000453062] [PMID: 27926905]
[124]
Kubo M, Umekawa T, Maekawa Y, et al. Retrospective study of tadalafil for fetal growth restriction: Impact on maternal and perinatal outcomes. J Obstet Gynaecol Res 2017; 43(2): 291-7.
[http://dx.doi.org/10.1111/jog.13218] [PMID: 27987345]
[125]
Coursen J, Simpson CE, Mukherjee M, et al. Pregnancy considerations in the multidisciplinary care of patients with pulmonary arterial hypertension. J Cardiovasc Dev Dis 2022; 9(8): 260.
[http://dx.doi.org/10.3390/jcdd9080260] [PMID: 36005424]
[126]
Paramothayan NS, Lasserson TJ, Wells AU, Walters EH. Prostacyclin for pulmonary hypertension in adults. Cochrane Database Syst Rev 2005; 2005(2): CD002994.
[PMID: 15846646]
[127]
Elliot CA, Stewart P, Webster VJ, et al. The use of iloprost in early pregnancy in patients with pulmonary arterial hypertension. Eur Respir J 2005; 26(1): 168-73.
[http://dx.doi.org/10.1183/09031936.05.00128504] [PMID: 15994404]
[128]
Avdalovic M, Sandrock C, Hoso A, Allen R, Albertson TE. Epoprostenol in pregnant patients with secondary pulmonary hypertension: Two case reports and a review of the literature. Treat Respir Med 2004; 3(1): 29-34.
[http://dx.doi.org/10.2165/00151829-200403010-00004] [PMID: 15174891]
[129]
Goland S, Tsai F, Habib M, Janmohamed M, Goodwin TM, Elkayam U. Favorable outcome of pregnancy with an elective use of epoprostenol and sildenafil in women with severe pulmonary hypertension. Cardiology 2010; 115(3): 205-8.
[http://dx.doi.org/10.1159/000287638] [PMID: 20173324]
[130]
Stewart R, Tuazon D, Duarte AG, Olson G. Pregnancy and primary pulmonary hypertension : Successful outcome with epoprostenol therapy. Chest 2001; 119(3): 973-5.
[http://dx.doi.org/10.1378/chest.119.3.973] [PMID: 11243988]
[131]
Wang T, Lu J, Li Q, et al. Rapid titration of intravenous treprostinil to treat severe pulmonary arterial hypertension postpartum: A retrospective observational case series study. Anesth Analg 2019; 129(6): 1607-12.
[http://dx.doi.org/10.1213/ANE.0000000000003827] [PMID: 31743181]
[132]
Bates SM, Rajasekhar A, Middeldorp S, et al. American society of hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Adv 2018; 2(22): 3317-59.
[http://dx.doi.org/10.1182/bloodadvances.2018024802] [PMID: 30482767]
[133]
Ho VT, Dua A, Lavignia K, Rothenberg K, Rao C, Desai SS. Thrombolysis for venous thromboembolism during pregnancy: A literature review. Vasc Endovasc Surg 2018; 52(7)
[http://dx.doi.org/10.1177/1538574418777822]
[134]
Rodriguez D, Jerjes-Sanchez C, Fonseca S, et al. Thrombolysis in massive and submassive pulmonary embolism during pregnancy and the puerperium: A systematic review. J Thromb Thrombolysis 2020; 50(4): 929-41.
[http://dx.doi.org/10.1007/s11239-020-02122-7] [PMID: 32347509]
[135]
Rosenzweig EB, Biscotti M, Cleary K, Smiley R, Bacchetta MD. Chronic thromboembolic pulmonary hypertension, pregnancy, and a pulmonary endarterectomy: A rare challenge. Pulm Circ 2016; 6(3): 384-8.
[http://dx.doi.org/10.1086/687158] [PMID: 27683616]
[136]
Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42(6): 563-645.
[http://dx.doi.org/10.1093/eurheartj/ehaa554] [PMID: 32860028]
[137]
Phoophiboon V, Pachinburavan M, Ruamsap N, Sanguanwong N, Jaimchariyatam N. Critical care management of pulmonary arterial hypertension in pregnancy: The pre-, peri- and post-partum stages. Acute Crit Care 2021; 36(4): 286-93.
[http://dx.doi.org/10.4266/acc.2021.00458] [PMID: 34762794]
[138]
Easter SR, Rouse CE, Duarte V, Hynes JS, Singh MN, Landzberg MJ, et al. Planned vaginal delivery and cardiovascular morbidity in pregnant women with heart disease. Am J Obstet Gynecol 2020; 77: e1-e11.
[139]
Leth RA, Møller JK, Thomsen RW, Uldbjerg N, Nørgaard M. Risk of selected postpartum infections after cesarean section compared with vaginal birth: A five-year cohort study of 32,468 women. Acta Obstet Gynecol Scand 2009; 88(9): 976-83.
[http://dx.doi.org/10.1080/00016340903147405] [PMID: 19642043]
[140]
Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL. Risks of venous thromboembolism after cesarean sections: A meta-analysis. Chest 2016; 150(3): 572-96.
[http://dx.doi.org/10.1016/j.chest.2016.05.021] [PMID: 27262227]
[141]
Chin KM, Channick RN, de Lemos JA, Kim NH, Torres F, Rubin LJ. Hemodynamics and epoprostenol use are associated with thrombocytopenia in pulmonary arterial hypertension. Chest 2009; 135(1): 130-6.
[http://dx.doi.org/10.1378/chest.08-1323] [PMID: 18719056]
[142]
Tita ATN, Szychowski JM, Rouse DJ, et al. Higher-dose oxytocin and hemorrhage after vaginal delivery: A randomized controlled trial. Obstet Gynecol 2012; 119(2, Part 1): 293-300.
[http://dx.doi.org/10.1097/AOG.0b013e318242da74] [PMID: 22227638]
[143]
Gallos ID, Williams HM, Price MJ, et al. Uterotonic agents for preventing postpartum haemorrhage: A network meta-analysis. Cochrane Database Syst Rev 2018; 4(4): CD011689.
[PMID: 29693726]
[144]
Sentilhes L, Sénat MV, Le Lous M, et al. Tranexamic acid for the prevention of blood loss after cesarean delivery. N Engl J Med 2021; 384(17): 1623-34.
[http://dx.doi.org/10.1056/NEJMoa2028788] [PMID: 33913639]
[145]
Duggan AB, Katz SG. Combined spinal and epidural anaesthesia for caesarean section in a parturient with severe primary pulmonary hypertension. Anaesth Intensive Care 2003; 31(5): 565-9.
[http://dx.doi.org/10.1177/0310057X0303100511] [PMID: 14601281]
[146]
Blaise G, Langleben D, Hubert B. Pulmonary arterial hypertension: Pathophysiology and anesthetic approach. Anesthesiology 2003; 99(6): 1415-32.
[http://dx.doi.org/10.1097/00000542-200312000-00027] [PMID: 14639158]
[147]
ACOG. Operative Vaginal Birth. Obstet Gynecol 2020; 135(4): e149-59.
[http://dx.doi.org/10.1097/AOG.0000000000003764] [PMID: 32217976]
[148]
Wang J, Lu J. Anesthesia for pregnant women with pulmonary hypertension. J Cardiothorac Vasc Anesth 2021; 35(7): 2201-11.
[http://dx.doi.org/10.1053/j.jvca.2020.06.062] [PMID: 32736999]
[149]
Rex S, Devroe S. Anesthesia for pregnant women with pulmonary hypertension. Curr Opin Anaesthesiol 2016; 29(3): 273-81.
[http://dx.doi.org/10.1097/ACO.0000000000000310] [PMID: 26978591]
[150]
Agerstrand C, Abrams D, Biscotti M, et al. Extracorporeal membrane oxygenation for cardiopulmonary failure during pregnancy and postpartum. Ann Thorac Surg 2016; 102(3): 774-9.
[http://dx.doi.org/10.1016/j.athoracsur.2016.03.005] [PMID: 27154158]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy