Management and outcome of pulmonary hypertension in pregnancy: Experience froma university hospital in northern Ethiopia

Abraha Hailu Weldegerima, Awol Yeman, Ermias Abate, Hale Teka, Haftom Berhane, Anna Whelan, Joan Briller, Heather Nixon, Hagos Godefay, Gelila Goba

Abstract


Introduction: Pulmonary hypertension (PH) is a rare disease and when associated with pregnancycan be devastating. In the developed world, maternal mortality from PH has decreased from 56% in the 1970s to 16% as of 2014. In the developing world, there are still many challenges in the management of these cases.

Objective: to review the management of such patients in a resource limited setting from September 2016 to September 2017.

Methods: Cases with severe PH were identified from high risk antenatal care follow up, cardiology clinic and wards. Severity and type of pulmonary hypertension, NYHA functional status, mode of delivery and anesthesia as well as neonatal and maternal outcomes were noted.

Results:21 cases of severe PH were reviewed.Seventeen of the patients had Rheumatic Heart Disease (RHD)(Group 2 PH, with average Mital Valve Area (MVA) of 0.9sqcm), 1 had pure congenital heart defect (CHD)/Membranous Ventricular Septal Defect (VSD)(Group 1 PH) and 3 had both CHD and RHD.The average pulmonary arterial pressure as measured on Echocardiography was 102.9 mmHg (SD 16.9).Fourteen of the patients had NYHA functional class III or more (66.7%), 10 patients underwent cesarean deliveries, 5 underwent vaginal deliveries with assisted second stage. Twopatients underwent termination of pregnancy at 16 &19 weeks and are alive.There were 4maternal deaths (19.1%) with a mean age at death of 28 years(SD 5.3). 76.2% of pregnancies resulted in live birth.

Key words: pulmonary hypertension, pregnancy, anesthesia


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