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Abstract
Published reports were reviewed to evaluate the characteristics of peripartal management
and the late pregnancy outcome in women with pulmonary vascular disease (PVD).
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.
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.
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.
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.