Outcomes of Pulmonary Hypertension in Pregnancy in an Academic Hospital in Ethiopia [31F

Abstract

INTRODUCTION: Pulmonary hypertension (PH) is a rare disease that is infrequently associated with pregnancy. However, when present in the parturient, it can be devastating. In the developed world, mortality from PH during pregnancy and postpartum decreased from 50% in the 1970s to 16% in 2014. Proper management requires a multidisciplinary team approach and close follow up. In the developing world, physicians face many challenges when caring for these complicated patients. METHODS: A case series of 20 patients with pulmonary hypertension who were treated at Mekelle University Hospital, Ethiopia. RESULTS: 20 cases of severe PH from September 2015 to September 2017 were reviewed. Average systolic pulmonary arterial pressure measured by echocardiography was 104.1 mmHg (SD 11.4, range 83-134 mmHg). Etiology was attributed to chronic rheumatic valvular heart disease in 17 patients and congenital heart defects in 3 patients. Eight patients had disease classified NYHA functional class III or IV heart failure (40%). There were 5 confirmed deaths (25%). Eleven patients underwent cesarean deliveries, 4 underwent vaginal deliveries with assisted second stage. Three patients underwent termination of pregnancy and 2 died prior to delivery. Death was caused by pulmonary edema in 3 cases and pulmonary venous thromboembolism in 2 cases. Sixty-five percent of pregnancies resulted in live birth. CONCLUSION: Pulmonary hypertension complicating pregnancy continues to be a highly morbid disease worldwide. Increased mortality in this study may reflect differences in etiology as well as delays in diagnosis and reduced access to healthcare. Multidisciplinary teams including cardiology, anesthesia, and obstetrics, are important to improving maternal and fetal outcomes.