Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996
BM Weiss,
L Zemp,
B Seifert,
and
OM Hess
Department of Anesthesiology, University Hospital, Zurich, Switzerland.
OBJECTIVES: Published reports were reviewed to evaluate the characteristics of peripartal management and the late pregnancy outcome in women with pulmonary vascular disease (PVD). BACKGROUND: Pulmonary hypertension poses one of the highest risks for maternal mortality, but actual data on the maternal and neonatal prognosis in this group are lacking. METHODS: Reports published from 1978 through 1996 of Eisenmenger's syndrome (n = 73), primary pulmonary hypertension (PPH) (n = 27) and secondary vascular pulmonary hypertension (SVPH) (n = 25) complicating late pregnancy were included and analyzed using logistic regression analysis. RESULTS: Maternal mortality was 36% in Eisenmenger's syndrome, 30% in PPH and 56% (p < 0.08 vs. other two groups) in SVPH. Except for three prepartal deaths due to Eisenmenger's syndrome, all fatalities occurred within 35 days after delivery. Neonatal survival ranging from 87% to 89% was similar in the three groups. Previous pregnancies, timing of the diagnosis and hospital admission, operative delivery and diastolic pulmonary artery pressure were significant univariate (p < 0.05) maternal risk factors. Late diagnosis (p = 0.002, odds ratio 5.4) and late hospital admission (p = 0.01, odds ratio 1.1 per week of pregnancy) were independent predictive risk factors of maternal mortality. CONCLUSIONS: In the last two decades maternal mortality was comparable in patients with Eisenmenger's syndrome and PPH; however, it was relevantly higher in SVPH. Maternal prognosis depends on the early diagnosis of PVD, early hospital admission, individually tailored treatment during pregnancy and medical therapy and care focused on the postpartal period.
This article has been cited by other articles:
|
|
|
|
 
A. Prabu, K. Patel, C.-S. Yee, P. Nightingale, R. D. Situnayake, D. R. Thickett, J. N. Townend, and C. Gordon
Prevalence and risk factors for pulmonary arterial hypertension in patients with lupus
Rheumatology,
December 1, 2009;
48(12):
1506 - 1511.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. V. McLaughlin, S. L. Archer, D. B. Badesch, R. J. Barst, H. W. Farber, J. R. Lindner, M. A. Mathier, M. D. McGoon, M. H. Park, R. S. Rosenson, et al.
ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association Developed in Collaboration With the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association
J. Am. Coll. Cardiol.,
April 28, 2009;
53(17):
1573 - 1619.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, V. V. McLaughlin, S. L. Archer, D. B. Badesch, R. J. Barst, H. W. Farber, J. R. Lindner, M. A. Mathier, M. D. McGoon, M. H. Park, et al.
ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: Developed in Collaboration With the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association
Circulation,
April 28, 2009;
119(16):
2250 - 2294.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Bedard, K. Dimopoulos, and M. A. Gatzoulis
Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension?
Eur. Heart J.,
February 1, 2009;
30(3):
256 - 265.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Presbitero, G. G. Boccuzzi, C. J.M. Groot, and J. W. Roos-Hesselink
CHAPTER 33 Pregnancy and Heart Disease
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
December 2, 2008;
52(23):
e143 - e263.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
December 2, 2008;
52(23):
1890 - 1947.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
December 2, 2008;
118(23):
e714 - e833.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al.
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
December 2, 2008;
118(23):
2395 - 2451.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. K Dhanjal
Contraception in women with medical problems
Obstet Med,
December 1, 2008;
1(2):
78 - 87.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Huang and E. R. H. DeSantis
Treatment of pulmonary arterial hypertension in pregnancy
Am. J. Health Syst. Pharm.,
September 15, 2007;
64(18):
1922 - 1926.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Gelson, M. Johnson, M. Gatzoulis, and A. Uebing
Cardiac disease in pregnancy. Part 1: congenital heart disease
Obstet Gynaecol (Lond),
January 1, 2007;
9(1):
15 - 20.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Thorne, A. MacGregor, and C. Nelson-Piercy
Risks of contraception and pregnancy in heart disease.
Heart,
October 1, 2006;
92(10):
1520 - 1525.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. V. McLaughlin and M. D. McGoon
Pulmonary Arterial Hypertension
Circulation,
September 26, 2006;
114(13):
1417 - 1431.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. J. Rubin and D. B. Badesch
Evaluation and Management of the Patient with Pulmonary Arterial Hypertension
Ann Intern Med,
August 16, 2005;
143(4):
282 - 292.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Elliot, P. Stewart, V. J. Webster, G. H. Mills, S. P. Hutchinson, E. S. Howarth, F. A. Bu'Lock, R. A. Lawson, I. J. Armstrong, and D. G. Kiely
The use of iloprost in early pregnancy in patients with pulmonary arterial hypertension
Eur. Respir. J.,
July 1, 2005;
26(1):
168 - 173.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Siva and A M Shah
Moderate mitral stenosis in pregnancy: the haemodynamic impact of diuresis
Heart,
January 1, 2005;
91(1):
e3 - e3.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Task Force members, N. Galie, A. Torbicki, R. Barst, P. Dartevelle, S. Haworth, T. Higenbottam, H. Olschewski, A. Peacock, G. Pietra, et al.
Guidelines on diagnosis and treatment of pulmonary arterial hypertension: The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology
Eur. Heart J.,
December 2, 2004;
25(24):
2243 - 2278.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Ray, G. J. Murphy, and L. E. Shutt
Recognition and management of maternal cardiac disease in pregnancy
Br. J. Anaesth.,
September 1, 2004;
93(3):
428 - 439.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W.-R. Chou, P.-H. Kuo, J.-C. Shih, and P.-C. Yang
A 31-Year-Old Pregnant Woman With Progressive Exertional Dyspnea and Differential Cyanosis
Chest,
August 1, 2004;
126(2):
638 - 641.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Child
Fallot's tetralogy and pregnancy: Prognostication and prophesy
J. Am. Coll. Cardiol.,
July 7, 2004;
44(1):
181 - 183.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. T. Lovell
Anaesthetic implications of grown-up congenital heart disease
Br. J. Anaesth.,
July 1, 2004;
93(1):
129 - 139.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. B. Badesch, S. H. Abman, G. S. Ahearn, R. J. Barst, D. C. McCrory, G. Simonneau, and V. V. McLaughlin
Medical Therapy For Pulmonary Arterial Hypertension: ACCP Evidence-Based Clinical Practice Guidelines
Chest,
July 1, 2004;
126(1_suppl):
35S - 62S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S A Thorne
Pregnancy in heart disease
Heart,
April 1, 2004;
90(4):
450 - 456.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Geohas and V. V. McLaughlin
Successful Management of Pregnancy in a Patient With Eisenmenger Syndrome With Epoprostenol
Chest,
September 1, 2003;
124(3):
1170 - 1173.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. F. Corno, P. Tozzi, C. Y. Genton, and L. K. von Segesser
Surgically induced unilateral pulmonary hypertension: time-related analysis of a new experimental model
Eur. J. Cardiothorac. Surg.,
April 1, 2003;
23(4):
513 - 517.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. D. J. Ten Harkel, N. A. Blom, and J. Ottenkamp
Isolated Unilateral Absence of a Pulmonary Artery: A Case Report and Review of the Literature
Chest,
October 1, 2002;
122(4):
1471 - 1477.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E Mcmillan, W L Martin, J Waugh, I Rushton, M Lewis, T Clutton-Brock, J N Townend, M D Kilby, and C Gordon
Management of pregnancy in women with pulmonary hypertension secondary to SLE and anti-phospholipid syndrome
Lupus,
June 1, 2002;
11(6):
392 - 398.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. C Siu and J. M Colman
CONGENITAL HEART DISEASE: Heart disease and pregnancy
Heart,
June 1, 2001;
85(6):
710 - 715.
[Full Text]
|
|
|
|
|
|
|
P. J. Cole, M. H. Cross, and M. Dresner
Incremental spinal anaesthesia for elective Caesarean section in a patient with Eisenmenger's syndrome
Br. J. Anaesth.,
May 1, 2001;
86(5):
723 - 726.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Stewart, D. Tuazon, G. Olson, and A. G. Duarte
Pregnancy and Primary Pulmonary Hypertension : Successful Outcome With Epoprostenol Therapy
Chest,
March 1, 2001;
119(3):
973 - 975.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P S C Wong, S Constantinides, V Kanellopoulos, C R Kennedy, D Watson, and M F Shiu
Primary pulmonary hypertension in pregnancy
J R Soc Med,
January 10, 2001;
94(10):
523 - 525.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E. Brickner, L. D. Hillis, and R. A. Lange
Congenital Heart Disease in Adults- Second of Two Parts
N. Engl. J. Med.,
February 3, 2000;
342(5):
334 - 342.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B.M Weiss and O.M Hess
Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives
Eur. Heart J.,
January 2, 2000;
21(2):
104 - 115.
[PDF]
|
|
|
|
