title: Pregnancy and pulmonary arterial hypertension: A clinical conundrum.
abstract: Pulmonary arterial hypertension (PAH) is a rare and devastating disease characterized by progressive increases in pulmonary arterial pressure and pulmonary vascular resistance which eventually leads to right ventricular failure and death. PAH inflicts most commonly women, majority of who are of childbearing age. Pregnancy in the setting of PAH is absolutely contraindicated due to high maternal fetal morbidity and guidelines do not exist for the management of such cases. A MEDLINE/PubMed search was performed identifying all relevant articles with "pulmonary arterial hypertension" and "pregnancy" in the title. Six case series were reviewed as well as our own center's experience outlined. Though there exists generalized treatment measures that are followed in such cases, management varies among different national centers as well an on an international level. At our center patients are managed using a multidisciplinary approach at a high risk obstetric center with preference for intravenous prostacyclin therapy. Women of child bearing age with possible signs and symptoms of PAH must be promptly diagnosed and managed expectantly with an emphasis on maternal-fetal safety.
authors.affiliation: North Shore - Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States. Electronic address: sahni.sonu@gmail.com.
authors.forename: Sonu
authors.initials: S
authors.lastname: Sahni
authors.affiliation: North Shore - Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States. Electronic address: apalkar@nshs.edu.
authors.forename: Atul V
authors.initials: AV
authors.lastname: Palkar
authors.affiliation: North Shore University Hospital, Department of Obstetrics and Gynecology, Division of Maternal/Fetal Medicine, 300 Community Drive, Manhasset, NY 11030, United States. Electronic address: brochels@nshs.edu.
authors.forename: Burton L
authors.initials: BL
authors.lastname: Rochelson
authors.affiliation: Pabianice Medical Center, ul. Jana Pawła II 68, 95-200 Pabianice, Poland. Electronic address: wiktorkepa@gmail.com.
authors.forename: Wiktor
authors.initials: W
authors.lastname: Kępa
authors.affiliation: North Shore - Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States. Electronic address: arunabh@nshs.edu.
authors.forename: Arunabh
authors.initials: A
authors.lastname: Talwar
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D036861:Delivery, Obstetric; D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D009569:Nitric Oxide / Q000502:physiology; D018743:Perinatal Care; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000188:drug therapy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011295:Prenatal Care; D011296:Prenatal Diagnosis; D014661:Vasoconstriction / Q000502:physiology; D014664:Vasodilation / Q000502:physiology; D014665:Vasodilator Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009569:Nitric Oxide
keywords: Congenital heart disease; Eisenmenger’s syndrome; High risk pregnancy; Pulmonary arterial hypertension; Pulmonary hypertension