title: Severe pulmonary hypertension during pregnancy: mode of delivery and anesthetic management of 15 consecutive cases.
abstract: BACKGROUND
  Available literature on pregnant women with severe pulmonary hypertension (PH) relies mainly on anecdotal case reports and two series only.
  
  
  METHODS
  The authors reviewed the charts of all pregnant women with severe PH who were followed up at their institution during the past 10 yr, to assess the multidisciplinary treatment and outcome of these patients.
  
  
  RESULTS
  Fifteen pregnancies in 14 women with severe PH were managed during this period: There were 4 cases of idiopathic pulmonary arterial hypertension (PAH), 6 cases of congenital heart disease-associated PAH, 1 case of fenfluramine-associated PAH, 1 case of mixed connective tissue-associated PAH, 1 case of human immunodeficiency virus-associated PAH, and 2 cases of chronic thromboembolic PH. PH presented during pregnancy in 3 patients. Two patients died before delivery at 12 and 23 weeks' gestation. Four patients had vaginal deliveries with regional anesthesia: One died 3 months postpartum, one worsened, and two remained stable. Four had cesarean deliveries during general anesthesia: One died 3 weeks postpartum, one worsened, and two remained stable. Five had cesarean deliveries during low-dose combined spinal-epidural anesthesia: One died 1 week postpartum, and four remained stable. There were two fetal deaths: one related to therapeutic abortion at 21 weeks' gestation and one stillbirth at 36 weeks' gestation followed by the death of the mother 1 week later.
  
  
  CONCLUSIONS
  Despite the most modern treatment efforts, the maternal mortality was 36%. Scheduled cesarean delivery during combined spinal-epidural anesthesia seemed to be an attractive approach, but there was no evidence of actual benefit. Therefore, pregnancy must still be discouraged in patients with severe PH.
authors.affiliation: Department of Anesthesiology and Intensive Care, Antoine Beclere Hospital-Assistance Publique des Hôpitaux de Paris (APHP), 157 rue de la Porte de Trivaux, 92141 Clamart Cedex, BP 405, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Bonnin
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Mercier
authors.forename: Olivier
authors.initials: O
authors.lastname: Sitbon
authors.forename: Sandrine
authors.initials: S
authors.lastname: Roger-Christoph
authors.forename: Xavier
authors.initials: X
authors.lastname: Jaïs
authors.forename: Marc
authors.initials: M
authors.lastname: Humbert
authors.forename: François
authors.initials: F
authors.lastname: Audibert
authors.forename: René
authors.initials: R
authors.lastname: Frydman
authors.forename: Gérald
authors.initials: G
authors.lastname: Simonneau
authors.forename: Dan
authors.initials: D
authors.lastname: Benhamou
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods; D002585:Cesarean Section / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality*; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome