Abstract
The association of pulmonary hypertension (PH) and pregnancy still leads to high maternal mortality. New treatments and a multidisciplinary approach have improved the course of pregnancies and fetal outcomes but not maternal prognosis. We observed that fetal evacuation and uterine involution coincides with marked worsening of maternal cardiac function, suggesting that the trigger is blood flow from the uterine muscle to the general circulation. This process acts as an autotransfusion and increases the pressure in the right heart to unsustainable limits. A new surgical technique, cesarean section in ischemia-hysterectomy, has been designed to prevent this event. This technique blocks uterine circulation before fetal extraction. We describe this technique and four cases.
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