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Federación Mexicana de Ginecología y Obstetricia, A.C.

2018, Number 08

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Ginecol Obstet Mex 2018; 86 (08)

Morbimortality and perinatal result in patients with pulmonary arterial hypertension

Vázquez-Rodríguez JG, De Alba-González AV

Language: Spanish
References: 31
Page: 510-518
PDF size: 314.85 Kb.


ABSTRACT

Objective: To determine morbimortality and perinatal result in pregnant patients with pulmonary arterial hypertension attended in an Intensive Care Unit of a thirdlevel medical center.
Materials and Methods: Observational, retrospective, cross-sectional and descriptive study including 12 pregnant patients with pulmonary arterial hypertension treated in Intensive Care Unit from 2013-2016. Morbidity, mortality and perinatal outcome were studied using a review of medical records. For statistical analysis, descriptive statistics (mean, median, standard deviation, range) with SPSS 17 program were used.
Results: We studied 12 patients of 27.2 ± 7.2 years, with a history of two births, gestational age of 35.5 ± care 3.8 ± 0.7 days with a stay in the intensive care unit of 1.7 ± 1.2 days. Pregnancy was interrupted, due to acute deterioration of maternal functional class, in 5/12 cases, 10/12 cases were completed in caesarean section. Anesthesia with epidural block was applied to 10/12 and 2/12 patients died. Twelve newborns with prematurity were obtained; of these, 6/12 required critical care and 1 died. The mean pulmonary arterial hypertension was 60.5 ± 18.0 mmHg, and Eisenmenger's syndrome was diagnosed in 7/12, with predominance of patent ductus arteriosus in 4/12. Sildenafil was used in 2/12, cardiovascular drugs in 3/12 and mechanical ventilation in 3/12.
Conclusion: Morbidity was high but not maternal-fetal mortality, probably due to the effect of treatment in Intensive Care Unit.


REFERENCES

  1. Wames CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the management of adults with congenital heart disease: executive summary. Circulation 2008; 118:2395-2451. doi: 10.1016/j.jacc.2008.10.002.

  2. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016; 37:67-119. https://doi.org/10.1093/ eurheartj/ehv317.

  3. Longmuir PE, Brothers JA, de Ferranti SD, et al. Promotion of physical activity for children and adults with congenital heart disease: a scientific statement from the American Heart Association. Circulation 2013;127:2147- 2159. https://doi.org/10.1161/CIR.0b013e318293688f.

  4. Yeomans ER, Gilstrap III LC. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med 2005;33(Suppl.):S256-S258. doi: 10.1097/01. CCM.0000183540.69405.90.

  5. Martínez MV, Rutherford JD. Pulmonary hypertension in pregnancy. Cardiol Rev 2013; 21:167-73. doi: 10.1097/ CRD.0b013e318275cf01.

  6. Wood P. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. Br Med J 1958;2(5099):755-762.

  7. Garofalo FB. El síndrome de Eisenmenger en el adulto. Rev Fed Arg Cardiol 2003; 32:84-92.

  8. Dimopoulos K, Wort SJ, Gatzoulis MA. Pulmonary hypertension related to congenital heart disease: a call for action. Eur Heart J 2014;35(11):691-700.

  9. Pijuan-Domenech A, Gatzoulis MA. Embarazo y cardiopatía. Rev Esp Cardiol 2006;59(9):971-984.

  10. Bouzas B, Gatzoulis MA. Pulmonary artery hypertension in adults with congenital heart disease. Rev Esp Cardiol 2005;58(5):465-469.

  11. Weiss BM, Zemp L, Seifert B, et al. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol 1998;31:1650-1657.

  12. Kiely DG, Condliffe R, Webster V, et al. Improved survival in pregnancy and pulmonary hypertension using a multiprofessional approach. BJOG 2010;117:565-574.

  13. D´Souza R, Sermer M, Silversides CK. Pregnancy in women with congenital heart disease. Obstetric Medicine 2015;8:18-25.

  14. Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl J Med 1998;338: 1128-1137.

  15. Qasqas S, McPherson C, Frishman WH, et al. Cardiovascular pharmacotherapeutic considerations during pregnancy and lactation. Cardiol Rev 2004;12:201-221.

  16. Jais X, Olsson KM, Barbera JA, et al. Pregnancy outcomes in pulmonary arterial hypertension in the modern management era. Eur Respir J 2012;40:881-885.

  17. Bonda K, Armitage JM, Paradis IL, et al. Indications for and results of single, bilateral and heart-lung transplantation for pulmonary hypertension. J Thorac Cardiovasc Surg 1994;108:1056-1065.

  18. Aeba R, Griffith BP, Hardesty RL, et al. Isolated lung transplantation for patients with Eisenmenger's syndrome. Circulation 1993;88(5 Pt 2):II452-455.

  19. Bolman III RM, Shumway SJ, Estrin JA, Hertz MI. Lung and heart-lung transplantation. Evolution and new applications. Ann Surg 1991;214:456-470.

  20. McLaughlin VV, Archer SL, Badesch DB, 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 2009;119:2250-2294. Disponible en: http://circ.ahajournals.org/content/119/16/2250

  21. Bonnin M, Mercier FJ, Sitbon O, et al. Severe pulmonary hypertension during pregnancy: mode of delivery and anesthetic management of 15 consecutive cases. Anesthesiology 2005;102:1133-1137.

  22. Bédard E, Dimopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J 2009;30:256–265.

  23. Mortalidad. Dirección General de Información en Salud. México. Secretaría de Salud. 2008. Disponible en: http://www.dgis. salud.gob.mx/contenidos/sinais/e_mortalidadgeneral.html

  24. Veloz-Martínez MG, Martínez-Rodríguez OA, Ahumada- Ramírez E, et al. Eclampsia, hemorragia obstétrica y cardiopatía como causa de mortalidad materna en 15 años de análisis. Ginecol Obstet Mex 2010;78:215-218.

  25. Thorne S, MacGregor A, Nelson-Piercy C. Risks of contraception and pregnancy in heart disease. Heart 2006;92:1520-1525.

  26. Guía de Práctica Clínica. Diagnóstico y Tratamiento de la Hipertensión Arterial Pulmonar Primaria en el Adulto. México. Secretaría de Salud. 2010. Disponible en: http:// www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/ 433-11_Hipertensixn_arterial_pulmonar/GER_Hipertensixn_ Arterial_Pulmonar.pdf

  27. Díaz RA, Parra WP, Uriarte-G de CP, Corvalán AJ, Varas CJ, Gómez EC, et al. Síndrome de Eisenmenger y embarazo: dos casos clínicos recientes y revisión de la literatura. Rev Obstet Ginecol Hosp Santiago Oriente Dr. Luis Tisné Brousse 2006;1:113-117.

  28. Perucca PE, Muñoz MP, Altamirano AR, et al. Síndrome de Eisenmenger y embarazo Rev Chil Obstet Ginecol 2007;72:125-129. Disponible en: http://dx.doi. org/10.4067/S0717-75262007000200011

  29. Correale M, D’Amato N, D’Agostino C, Di Biase M. Eisenmenger’s syndrome in pregnancy. J Cardiovasc Med 2013;14:384-387.

  30. Laguarda M. Anestesia raquídea en síndrome de Eisenmenger y gestación. Prog Obstet Ginecol 2000;43:426-430.

  31. Mishra L, Pani N, Samantaray R, et al. Eisenmenger’s syndrome in pregnancy: Use of epidural anesthesia and analgesia for elective cesarean section. J Anaesthesiol Clin Pharmacol 2014;30:425-426.




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