Maternal outcome in pregnancy complicated with pulmonary arterial hypertension.
BACKGROUND
Pulmonary arterial hypertension (PAH), including Eisenmenger syndrome, has a risk of mortality in pregnancy of 10-40%. The aim of this study was to investigate whether pulmonary artery blood pressure (PABP) is a prognostic factor for pregnancy outcome in patients with PAH.


RESULTS
The subjects were 42 patients with PAH during pregnancy. Severe and mild cases were defined by PABP before and during the first 14 weeks of pregnancy, with severe cases having mean PABP >40 mmHg by catheterization or systolic PABP >50 mmHg on echocardiography. Eighteen women chose termination of pregnancy before 14 weeks, leaving 24 women (10 mild, 14 severe) for analysis. The women with severe PAH delivered earlier (35.4 vs. 31.5 weeks, P<0.05) and had higher rates of small-for-gestational-age infants (0/10 vs. 7/14, P<0.01). Among the women with severe PAH, the New York Heart Association class dropped by 1 in 9 cases, by 2 in 3 cases, and remained the same in 2 cases as pregnancy progressed, whereas among the women with mild PAH, the class dropped by 1 in 1 case and 9 women remained in the same class. Among the severe cases, 1 woman died and there was 1 fetal death; PABP markedly increased in later pregnancy from 54 to 74 mmHg (catheter measurement) and from 78 to 93 mmHg (echocardiography) (P<0.05).


CONCLUSIONS
The level of PABP before or in the early stage of pregnancy is an important predictor of pregnancy outcome.
Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan. skatsura12@yahoo.co.jp
Shinji
S
Katsuragi
Kaoru
K
Yamanaka
Reiko
R
Neki
Chizuko
C
Kamiya
Yoshihito
Y
Sasaki
Kazuhiro
K
Osato
Takekazu
T
Miyoshi
Kaoru
K
Kawasaki
Chinami
C
Horiuchi
Yoshinari
Y
Kobayashi
Keiko
K
Ueda
Jun
J
Yoshimatsu
Koichiro
K
Niwa
Yaemi
Y
Takagi
Takeshi
T
Ogo
Norifumi
N
Nakanishi
Tomoaki
T
Ikeda
D000328:Adult; D001794:Blood Pressure; D004541:Eisenmenger Complex / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000503:physiopathology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies