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

Abraha Hailu Weldegerima | Bio
cardiology
Awol Yeman
Mekele University
Ermias Abate
Mekelle university – College of Health Sciences, department of Anesthesia, Ethiopia
Hale Teka
Mekelle university – College of Health Sciences, department of Obstetrics and Gynecology, Ethiopia
Haftom Berhane
Mekelle university – College of Health Sciences, department of Anesthesia, Ethiopia
Anna Whelan
University of Illinois, Department of Obstetrics and Gynecology, Chicago, USA
Joan Briller
University of Illinois, Cardiology, Chicago, USA
Heather Nixon
University of Illinois, Department of anesthesiology, Chicago, USA
Hagos Godefay
Tigray Regional Health Bureau, Ethiopia
Gelila Goba
University of Illinois, Department of Obstetrics and Gynecology, Chicago, USA
Share:
  • Articles
  • Submited: April 27, 2018
  • Published: June 28, 2019

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

Downloads

Download data is not yet available.

References

  1. References
  2. Hemnes AR, Kiely DG, Cockrill BA, Safdar Z, Wilson VJ, Al Hazmi M, Preston IR, MacLean MR, Lahm T. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute. Pulmonary circulation. 2015 Jul 8;5(3):435-65.
  3. Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. Journal of the American College of Cardiology. 1998 Jun 30;31(7):1650-7.
  4. Bédard E, Dimopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? European heart journal. 2009 Jan 15;30(3):256-65.
  5. Jaïs X, Olsson KM, Barbera JA, Blanco I, Torbicki A, Peacock A, Vizza CD, Macdonald P, Humbert M, Hoeper MM. Pregnancy outcomes in pulmonary arterial hypertension in the modern management era. European Respiratory Journal. 2012 Oct 1;40(4):881-5.
  6. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: The 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 the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2009; 30:2493?537.
  7. Carvalho J: Cardiovascular disease in the pregnant patient, Textbook of Obstetric Anesthesia. Edited by Birnbach DJ, Gatt SP, Datta S. Philadelphia, Churchill Livingstone, 2000, pp 553–64
  8. Cheek TG, Gutsche BB: Maternal physiologic alteration during pregnancy, Shnider and Levinson’s Anesthesia for Obstetrics. Edited by Hugues SC, Levinson G, Rosen MA. Philadelphia, Lippincott Williams & Wilkins, 2001, pp 3–18
  9. 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.
  10. Kiely DG, Condliffe R, Webster V, Mills GH, Wrench I, Gandhi SV, Selby K,Armstrong IJ, Martin L, Howarth ES, Bu'lock FA, Stewart P, Elliot CA. Improved survival in pregnancy and pulmonary hypertension using a multiprofessional approach. BJOG. 2010 Apr;117(5):565-74.
  11. Bonnin M, Mercier FJ, Sitbon O, Roger-Christoph S, Jaïs X, Humbert M, Audibert F, Frydman R, Simonneau G, Benhamou D. Severe pulmonary hypertension during pregnancy: mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiology. 2005 Jun;102(6):1133-7; discussion 5A-6A.
  12. Easterling TR, Ralph DD, Schmucker BC: Pulmonary hypertension in pregnancy: Treatment with pulmonary vasodilatators. ObstetGynecol 1999; 93: 494–8
  13. Smedstad KG, Cramb R, Morison DH: Pulmonary hypertension and pregnancy:A series of eight cases. Can J Anaesth 1994; 41:502–12
  14. Slomka F, Salmeron S, Zetlaoui P, Cohen H, Simonneau G, Samii K: Primary pulmonary hypertension and pregnancy: anesthetic management for delivery. ANESTHESIOLOGY 1988; 69:959–61
  15. Jean M. Elwing and Ralph J. Panos (2011). Pregnancy and Pulmonary Arterial Hypertension, Pulmonary Hypertension - From Bench Research to Clinical Challenges, Dr. Roxana Sulica (Ed.), ISBN: 978-953-307- 835-9, InTech, Available from http://www.intechopen.com/books/pulmonary-hypertension-from-benchresearch-to-clinical-challenges/pregnancy-and-pulmonary-arterial-hypertension
  16. O’Hare R, McLoughlin C, Milligan K, McNamee D, Sidhu H: Anaesthesia for caesarean section in the presence of severe primary pulmonary hypertension. Br J Anaesth 1998; 81:790–2
  17. Monnery L, Nanson J, Charlton G: Primary pulmonary hypertension in pregnancy: A role for novel vasodilatators. Br J Anaesth 2001; 87:295–8
  18. Blaise G, Langleben D, Hubert B: Pulmonary arterial hypertension: Pathophysiology and anesthetic approach. Anesthesiology 2003; 99:1415–32.
  19. Madden BP. Pulmonary hypertension and pregnancy. Int J ObstetAnesth. 2009 Apr;18(2):156-64.
  20. Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR. Definitions and diagnosis of pulmonary hypertension. Journal of the American College of Cardiology. 2013 Dec 24;62(25 Supplement):D42-50.
  21. Yadeta D, Hailu A, Haileamlak A, Gedlu E, Guteta S, Tefera E, Tigabu Z, Tesfaye H, Daniel W, Mekonnen D, Zelalem M. Prevalence of rheumatic heart disease among school children in Ethiopia: A multisite echocardiography-based screening. International journal of cardiology. 2016 Oct 15;221:260-3.
  22. Yadeta D, Guteta S, Alemayehu B, Mekonnen D, Gedlu E, Benti H, Tesfaye H, Berhane S, Hailu A, Luel A, Hailu T. Spectrum of cardiovascular diseases in six main referral hospitals of Ethiopia. Heart Asia. 2017 Jul 1;9(2):e010829.
  23. Oli K, Asmera J. Rheumatic heart disease in Ethiopia: could it be more malignant?. Ethiopian medical journal. 2004 Jan;42(1):1-8.
  24. Thienemann F, Dzudie A, Mocumbi AO, Blauwet L, Sani MU, Karaye KM, Ogah OS, Mbanze I, Mbakwem A, Udo P, et al. Rationale and design of the pan African pulmonary hypertension cohort (PAPUCO) study: implementing a contemporary registry on pulmonary hypertension in Africa. BMJ Open. 2014;4(10):e005950
  25. Weiss BM, Maggiorini M, Jenni R, Lauper U, Popov V, Bombeli T, Spahn DR. Pregnant patient with primary pulmonary hypertension: inhaled pulmonary vasodilators and epidural anesthesia for cesarean delivery. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2000 Apr 1;92(4):1191-.
How to Cite
Weldegerima, A. H., Yeman, A., Abate, E., Teka, H., Berhane, H., Whelan, A., Briller, J., Nixon, H., Godefay, H., & Goba, G. (2019). Management and outcome of pulmonary hypertension in pregnancy: Experience froma university hospital in northern Ethiopia. Ethiopian Medical Journal, 57(3). Retrieved from https://emjema.org/index.php/EMJ/article/view/966

Send mail to Author


Send Cancel