title: Intravenous and inhaled epoprostenol for primary pulmonary hypertension during pregnancy and delivery.
abstract: BACKGROUND
  Primary pulmonary hypertension carries a significant mortality risk during pregnancy and delivery.
  
  
  METHODS
  A 36-year-old pregnant woman with primary pulmonary hypertension was transferred to us with severe dyspnea. Intravenous epoprostenol was started, titrated, and maintained until labor augmentation. Because systemic epoprostenol treatment can interfere with platelet aggregation, we switched to inhaled epoprostenol, administered under a U.S. Food and Drug Administration-approved investigational new drug license, before epidural catheter placement. The inhaled drug was continued because it achieved better control of pulmonary hypertension. An uneventful forceps-assisted vaginal delivery was performed, and intravenous epoprostenol was restarted after the delivery. Mother and baby were well 6 months postpartum.
  
  
  CONCLUSIONS
  Intravenous epoprostenol treatment is effective in management of pregnant and postpartum women with primary pulmonary hypertension. Inhaled epoprostenol was effective during the intrapartum and immediate postpartum period.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, Barnes Jewish Hospital, St Louis, Missouri 63110, USA. bildiricii@msnotes.wustl.edu
authors.forename: I
authors.initials: I
authors.lastname: Bildirici
authors.forename: J B
authors.initials: JB
authors.lastname: Shumway
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D036861:Delivery, Obstetric / Q000379:methods; D011464:Epoprostenol / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007744:Obstetric Labor Complications / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol