Pulmonary hypertension in pregnancy. A narrative review.
Abstract
Pulmonary hypertension is a disease with a high burden in terms of morbidity and mortality; pregnant women with this diagnosis should receive a multidisciplinary approach in order to carry out an adequate and timely treatment. In addition, according to the severity of the condition, the best approach will be defined in order to reduce adverse maternal fetal outcomes.
The recommendation to patients with a known diagnosis who attend the preconception consultation is non-conception. However, if it occurs inadvertently, termination of this should be offered in the first trimestre. If it is decided to continue with the pregnancy, it should establish a pharmacological treatment, delivery route and postpartum management according to maternal conditions and severity of the pathology. Observation in an intensive care unit during labor and for up to one week after labor is recommended in order to detect complications early.
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Disciplines:
Gynecology and Obstetrics, Critical medicine and intensive careReferences
Garg N, Martin S. Pulmonary Hypertension in Pregnancy. En: Hameed AB, Wolfe D, editors. Cardio obstetrics: a practical guide to care for pregnant cardiac patients. First edition. Boca Raton: CRC Press. 2020. p. 135-43. https://doi.org/10.1201/9780429454912
Sahni S, Palkar AV, Rochelson BL, Kępa W, Talwar A. Pregnancy and pulmonary arterial hypertension: A clinical conundrum. Pregnancy Hypertens Int J Womens Cardiovasc Health. 2015;5(2):157-64. https://doi.org/10.1016/j.preghy.2015.01.004
Olsson KM, Channick R. Pregnancy in pulmonary arterial hypertension. Eur Respir Rev. 2016; 25(142): 431-7. https://doi.org/10.1183/16000617.0079-2016
Sliwa K, van Hagen IM, Budts W, Swan L, Sinagra G, Caruana M, et al. Pulmonary hypertension and pregnancy outcomes: data from the Registry Of Pregnancy and Cardiac Disease (ROPAC) of the European Society of Cardiology: Pulmonary hypertension in pregnancy. Eur J Heart Fail. 2016; 18(9): 1119-28. https://doi.org/10.1002/ejhf.594
Bedard 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. https://doi.org/10.1093/eurheartj/ehn597
Klinger JR, Elliott CG, Levine DJ, Bossone E, Duvall L, Fagan K, et al. Therapy for Pulmonary Arterial Hypertension in Adults. Chest. 2019; 155(3): 565-86. https://doi.org/10.1016/j.chest.2018.11.030
Hemnes AR, Kiely DG, Cockrill BA, Safdar Z, Wilson VJ, Hazmi MA, et al. Statement on Pregnancy in Pulmonary Hypertension from the Pulmonary Vascular Research Institute. Pulm Circ. 2015; 5(3): 435-65. https://doi.org/10.1086/682230
Múnera-Echeverri AG. Heart disease and pregnancy. Rev Colomb Cardiol. 2018; 25:49-58. https://doi.org/10.1016/j.rccar.2017.11.028
Meng M-L, Landau R, Viktorsdottir O, Banayan J, Grant T, Bateman B, et al. Pulmonary Hypertension in Pregnancy: A Report of 49 Cases at Four Tertiary North American Sites. Obstet Gynecol. 2017;129(3):511-20. https://doi.org/10.1097/AOG.0000000000001896
Thomas CA, Anderson RJ, Condon DF, Perez VADJ. Diagnosis and Management of Pulmonary Hypertension in The Modern Era: Insights from the 6th World Symposium. Pulm Ther. 2020; 6(1): 9-22. https://doi.org/10.1007/s41030-019-00105-5
Ballard W, Dixon B, McEvoy CA, Verma AK. Pulmonary Arterial Hypertension in Pregnancy. Cardiol Clin. 2021; 39(1): 109-18. https://doi.org/10.1016/j.ccl.2020.09.007
Sahay S. Evaluation and classification of pulmonary arterial hypertension. J Thorac Dis. 2019; 11(S14): S1789–99. https://doi.org/10.21037/jtd.2019.08.54
Condon DF, Nickel NP, Anderson R, Mirza S, de Jesus Perez VA. The 6th World Symposium on Pulmonary Hypertension: what’s old is new. F1000Research. 2019; 8: F1000. https://doi.org/10.12688%2Ff1000research.18811.1
Beshay S, Sahay S, Humbert M. Evaluation and management of pulmonary arterial hypertension Respir Med. 2020; 171:106099. https://doi.org/10.1016/j.rmed.2020.106099
Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019; 53(1). https://doi.org/10.1183/13993003.01913-2018
Galiè N, McLaughlin VV, Rubin LJ, Simonneau G. An overview of the 6th World Symposium on Pulmonary Hypertension. Eur Respir J. 2019; 53(1): 1802148. https://doi.org/10.1183/13993003.02148-2018
Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, et al. Delay in Recognition of Pulmonary Arterial Hypertension. Chest. 2011; 140(1):19-26. https://doi.org/10.1378/chest.10-1166
Galiè N, Humbert M, Vachiery J-L, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Respir J. 2015; 46(4): 903-75. https://doi.org/10.1183/13993003.01032-2015
Frost A, Badesch D, Gibbs JSR, Gopalan D, Khanna D, Manes A, et al. Diagnosis of pulmonary hypertension. Eur Respir J. 2019; 53(1): 1801904. https://doi.org/10.1183/13993003.01904-2018
Lane CR, Trow TK. Pregnancy and Pulmonary Hypertension. Clin Chest Med. 2011; 32(1): 165-74. https://doi.org/10.1016/j.ccm.2010.10.006
Martin SR, Edwards A. Pulmonary Hypertension and Pregnancy: Obstet Gynecol. 2019; 134(5): 974–87. https://doi.org/10.1097/AOG.0000000000003549
Zaidan MF, Duarte AG. Pulmonary Hypertension in Pregnancy. En: Phelan JP, editor. Critical care obstetrics. 6th edition. Hoboken, NJ, USA: Wiley-Blackwell; 2018. p. 775-90.
Pieper PG, Hoendermis ES. Pregnancy in women with pulmonary hypertension. Neth Heart J. 2011; 19(12): 504-8. https://doi.org/10.1007/s12471-011-0219-9
Zagolin M, Llancaqueo M. Pulmonary hypertension: importance of early diagnosis and specific treatment. Rev Médica Clínica Las Condes. 2015; 26(3): 344–56. https://doi.org/10.1016/j.rmclc.2015.06.009
Pieper PG, Lameijer H, Hoendermis ES. Pregnancy and pulmonary hypertension. Best Pract Res Clin Obstet Gynaecol. 2014; 28(4): 579–91. https://doi.org/10.1016/j.bpobgyn.2014.03.003
Marín R, de la Sierra A, Armario P, Campo C, Banegas JR, Gorostidi M, et al. [2005 Spanish guidelines in diagnosis and treatment of arterial hypertension].Med Clin (Barc). 2005; 125(1): 24-34. https://doi.org/10.1157/13076402
Elkayam U, Goland S, Pieper PG, Silversides CK. High-Risk Cardiac Disease in Pregnancy. J Am Coll Cardiol. 2016; 68(5): 502–16. https://doi.org/10.1016/j.jacc.2016.05.050
Duarte AG, Thomas S, Safdar Z, Torres F, Pacheco LD, Feldman J, et al. Management of Pulmonary Arterial Hypertension During Pregnancy. Chest. 2013; 143(5): 1330-6. https://doi.org/10.1378/chest.12-0528
Moreno-Escallón B. Vaginal misoprostol in pregnant low risk outpatients at term for selective induction of labor. Cohort Study. Rev Colomb Obstet Ginecol. 2012;63(1):64–72. https://doi.org/10.18597/rcog.204
Lopez M, Gracia M, Martínez-Ocón J, Blanco I. Manejo obstétrico-ginecológico en pacientes con hipertensión pulmonar [Internet]. Barcelona, España. Clinic Barcelona Hospital Universitario; 2020 [Consultado: 21 enero 2021]. Disponible en: https://docs.google.com/viewerng/viewer?url=https://medicinafetalbarcelona.org/protocolos/es/patologia-materna-obstetrica/hipertension-pulmonar.pdf
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 201; 39(34): 3165-241. https://doi.org/10.1093/eurheartj/ehy340.
Asociación Argentina de Medicina Respiratoria. Guías Argentinas de Consenso en Diagnóstico y Tratamiento de la Hipertensión Pulmonar. Revista Americana de Medicina Respiratoria. 2017; 17(4): 266-336. Disponible en: https://www.aamr.org.ar/recursos_educativos/consensos/guias_arg_consenso_hp_ramr_2017.pdf
Kramer Mordechai. Pulmonary Hypertension and Pregnancy: Management and Outcome. Journal of Pulmonary & Respiratory Medicine. 2013; 10.4172/2161-105X.S4-004. http://dx.doi.org/10.4172/2161-105X.S4-0047
Madden BP. Pulmonary hypertension and pregnancy. Int J Obstet Anesth. 2009; 18(2): 156-64. https://doi.org/10.1016/j.ijoa.2008.10.006
Banerjee D, Ventetuolo C. Pulmonary Hypertension in Pregnancy. Semin Respir Crit Care Med. 2017; 38(02): 148-59. https://doi.org/10.1055/s-0037-1602242.
Castillo-Luna R, Miranda-Araujo O. Obstetric management in patients with severe pulmonary hypertension. Ginecol Obstet Mex. 2015; 83(12): 785–97.
Običan SG, Cleary KL. Pulmonary arterial hypertension in pregnancy. Semin Perinatol. 2014; 38(5): 289–94. https://doi.org/10.1053/j.semperi.2014.04.018
Arendt KW, Lindley KJ. Obstetric anesthesia management of the patient with cardiac disease. Int J Obstet Anesth. 2019; 37: 73–85. https://doi.org/10.1016/j.ijoa.2018.09.011