Multidisciplinary Management Pulmonary Arterial Hypertension in Pregnancy

Abstract

Poster Presentation Background Pulmonary arterial hypertension (PAH) is rare in pregnancy. Pregnancy exacerbates PAH symptoms and increases the risks for heart failure and maternal and fetal morbidity and mortality. Management of the woman and fetus is highly complex. Vigilant care using a multidisciplinary team approach can facilitate positive maternal and fetal outcomes. Case A 23‐year‐old G1P0 woman was originally diagnosed with idiopathic PAH at age 20 after a syncopal episode. Her medical history also included obesity and depression. She was unemployed, lived with her boyfriend, and denied tobacco or alcohol use. She did admit to use of marijuana prior to pregnancy. During her pregnancy the woman was counseled on the risks of carrying the pregnancy to term. She was informed that the maternal mortality rate was approximately 17% with the highest risk in the postpartum period. She was counseled on termination, but she strongly desired to keep the pregnancy. Her boyfriend was very supportive of her decision. The woman had frequent appointments throughout the pregnancy with a team of health care providers. Cardiac echocardiograms were done every 5 weeks. The woman presented in preterm labor at 34.4 weeks gestation with abdominal and vaginal pain. A multidisciplinary team determined that the best option would be for the woman to give birth at the medical center next to the tertiary women's hospital. The intensive care unit had extracorporeal membrane oxygenation capability and a medical team comfortable with managing the woman's pulmonary and cardiac medical condition. Two teams from the women's hospital relocated to the medical center to care for her during her labor and delivery course. One team cared for the woman, and the other team cared for the newborn at birth. The infant was transferred to the neonatal care unit for care postdelivery. The woman spent the initial postpartum period in the intensive care unit at the medical facility. Once her condition improved, she was transferred to the women's facility for further care enabling her to be closer to her newborn. Conclusion Pulmonary arterial hypertension during pregnancy can be life threatening for the woman and newborn. Communication, collaboration, and flexibility among multiple disciplines led to a positive outcome for mother and newborn.