Pulmonary hypertension and pregnancy--a review of 12 pregnancies in nine women

Objective: To report outcomes in a recent series of pregnancies in women with pulmonary hypertension (PH).

Design: Retrospective case note review.

Setting: Tertiary referral unit (Chelsea and Westminster and Royal Brompton Hospitals).

Sample: Twelve pregnancies in nine women with PH between 1995 and 2010.

Methods: Multidisciplinary review of case records.

Main outcome measures: Maternal and neonatal mortality and morbidity.

Results: There were two maternal deaths (1995 and 1998), one related to pre-eclampsia and one to arrhythmia. Maternal morbidity included postpartum haemorrhage (five cases), and one post-caesarean evacuation of a wound haematoma. There were no perinatal deaths, nine live births and three first-trimester miscarriages. Mean birthweight was 2197 g, mean gestational age was 34 weeks (range 26-39), and mean birthweight centile was 36 (range 5-60). Five babies required admission to the neonatal intensive care unit, but were all eventually discharged home. All women were delivered by caesarean section (seven elective and two emergency deliveries), under general anaesthetic except for one emergency and one elective caesarean performed under regional block.

Conclusions: Maternal and fetal outcomes for women with PH may be improving. However, the risk of maternal mortality remains significant, so that early and effective counselling about contraceptive options and pregnancy risks should continue to play a major role in the management of such women when they reach reproductive maturity.