Pulmonary arterial hypertension and pregnancy
The historic mortality among women with pulmonary arterial hypertension (PAH) who choose to endure pregnancy and delivery has been consistently reported between 30% and 60%. The normal physiologic changes during pregnancy and the postpartum period can cause serious complications, including death, in women with PAH. Perhaps the single greatest improvement to maternal and fetal survival among pregnant women with PAH is the establishment and implementation of a multidisciplinary team. Each team member is expected to understand their role in the pre-management, intra-management, and post-management of women with PAH and the newborn. There is risk associated with all forms of conventional anesthesia among patients with PAH. All women agreed to epidural anesthetic for labor/delivery, with a vaginal delivery planned unless an absolute obstetrical reason for a cesarean-section delivery was present.
