title: Pulmonary hypertension and pregnancy: the experience of a tertiary institution over 15 years.
abstract: BACKGROUND
  Pulmonary hypertension (PH) in pregnancy is associated with a high maternal mortality and morbidity and has been found to be as high as 30-56%.
  
  
  OBJECTIVE
  To review the management of such patients in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small case series and 2 meta-analyses.
  
  
  METHODS
  A review of all patients admitted to our institution for management of PH in pregnancy between 1994 and February 2009 was undertaken. Cases were identified from the high-risk pregnancy database within the department of anesthesia and from the hospital medical records. Severity of PH, type of PH, NYHA functional status at presentation and delivery, mode of delivery, peripartum monitoring and APGAR scores were noted. Patients were reviewed by a multidisciplinary team and management planned accordingly.
  
  
  RESULTS
  19 eligible patients were identified. Patients who were significantly sick due to their PH were aggressively managed during pregnancy. Overall there was an improvement in NYHA functional status at the time of delivery. Epidural analgesia and anesthesia for labor and operatively delivery seem to be the ideal choice.
  
  
  CONCLUSIONS
  Multidisciplinary approach is a key to the successful management of these patients. Secondary PH results in higher morbidity and mortality, in particular, older the age higher the maternal morbidity and mortality.
authors: John
authors: J
authors: Monagle
authors: Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Clayton, Victoria 3168, Australia.
authors: Shashikanth
authors: S
authors: Manikappa
authors: Brendan
authors: B
authors: Ingram
authors: Vangy
authors: V
authors: Malkoutzis
mesh_terms: D000328:Adult; D000367:Age Factors; D001034:Apgar Score; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology*; D007231:Infant, Newborn; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012720:Severity of Illness Index; D062606:Tertiary Care Centers