Postpartum sudden death from pulmonary hypertension in the setting of portal hypertension.
BACKGROUND
Pulmonary arterial hypertension carries a high maternal mortality rate in the peripartum period. Pulmonary hypertension may arise as a complication of portal hypertension with poor patient survival.


METHODS
A young primigravida with chronic autoimmune hepatitis and portal hypertension presented at 26 4/7 weeks of gestation with contractions and bleeding. Within 48 hours, an 892-g female fetus was delivered vaginally without complications. On postpartum day 2, the mother was found on the floor by her bed. Although initially responsive, within minutes she was unresponsive and resuscitation was unsuccessful. Postmortem examination showed cirrhosis and plexogenic pulmonary arteriopathy.


CONCLUSIONS
Increased awareness of pulmonary hypertension as a complication of portal hypertension and a high index of clinical suspicion are necessary to diagnose pregnant women with this condition and provide appropriate prenatal counseling and peripartum intervention.
Department of Pathology, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599-7525, USA.
Carlie S
CS
Sigel
Teresa C
TC
Harper
Leigh B
LB
Thorne
D000328:Adult; D003645:Death, Sudden; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D006976:Hypertension, Pulmonary / Q000209:etiology*; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000150:complications; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology*; D011256:Pregnancy Outcome; D012307:Risk Factors