Pregnancy in pulmonary arterial hypertension: mid-term outcomes of mothers and offspring

Current pulmonary hypertension guidelines recommend that patients with pulmonary arterial hypertension (PAH) avoid pregnancy because of high mortality risk for patients and offspring. Still, some patients become pregnant. The experiences we made over the last 12 years encouraged for a retrospective view on pregnancy outcomes in our PAH patient base. We herein report the mid-term maternal and offspring outcomes of 25 consecutive pregnancies in 16 patients with PAH between 2007 and 2019. Five patients had a total of 8 abortions (5 spontaneous, 3 induced; one of these patients developed right ventricular failure and underwent urgent lung transplantation). Thirteen patients delivered a total of 18 healthy children. One of these patients developed right heart failure in the postpartum period, requiring urgent lung transplantation (both patients developing right heart failure were strongly advised against pregnancy). All other patients were alive after a follow-up period of 1-12 (median, 6) years, 6 patients showed worsening within 9-22 months after delivery but responded favorably to therapy escalation. Their infants were also doing well and had normal results on a standardized infant developmental questionnaire. Today, an individualized risk-based approach with shared decision making may be an appropriate approach to pregnancy in PAH.Reference:Kamp JC et al. Pregnancy in pulmonary arterial hypertension: Mid-term outcomes of mothers and offspring. J Heart Lung Transplant. 2020 Dec...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Pulmonary hypertension Source Type: research

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Rationale: Pregnancy in a woman with pulmonary hypertension (PH) carries prohibitively high risks of cardiopulmonary complications and high maternal and fetal morbidity and mortality. Anaesthetic management during delivery or cesarean section is very important for the prognosis of pregnant women with PH. The choice between general anesthesia or intraspinal anesthesia is controversial. There have been few case reports of anesthetic management under continuous epidural anesthesia with double catheters in such patients. Patient concerns: A 35-year-old pregnant woman presented to the emergency department with fatigu...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
CONCLUSION: Loco-regional anaesthesia is to be preferred in pulmonary hypertension associated to pregnancy. In order to reduce the risk of mortality due to general anaesthesia for this type of patient, it is possible to practice the continuous spinal anaesthesia for caesarean section without having hemodynamic consequences.PMID:34703586 | PMC:PMC8521236 | DOI:10.1016/j.amsu.2021.102923
Source: Annals of Medicine - Category: Internal Medicine Authors: Source Type: research
SPRING HOUSE, PENNSYLVANIA, October 25, 2021 – The Janssen Pharmaceutical Companies of Johnson &Johnson today announced data from two new analyses of STELARA® (ustekinumab) for the treatment of adults with moderately to severely active Crohn’s disease (CD) and ulcerative colitis (UC).1,2 In a modelled analysisa focused on treatment sequencing using data from randomized controlled trials, network meta-analysis and literature, results showed patient time spent in clinical remission or response was highest when STELARA was used as a first-line advanced therapy for bio-naïve patients with moderately to...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
TITUSVILLE, N.J. – October 14, 2021 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today 11* abstracts highlighting data from its pulmonary hypertension (PH) portfolio will be presented at CHEST 2021, the annual meeting of the American College of Chest Physicians, held virtually October 17-20.Data presentations from eight abstracts will provide additional evidence supporting the role of objective multiparameter risk assessment approaches in helping to optimize treatment and care for pulmonary arterial hypertension (PAH), as well as the impact of earlier and comprehensive therapy with U...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
CONCLUSIONS: Pregnancy with ES is still associated with very high maternal neonatal mortality and morbidity. The larger defect size is correlated with clinical performances and pregnancy outcomes. Effective preconception counseling is the best strategy to reduce the risk of maternal and neonatal death in ES women.PMID:34616573 | PMC:PMC8490032 | DOI:10.1155/2021/3248850
Source: Journal of Pregnancy - Category: OBGYN Authors: Source Type: research
Int Heart J. 2021 Sep 17. doi: 10.1536/ihj.20-807. Online ahead of print.ABSTRACTThis retrospective cohort study aimed to explore the relationship between temporal changes in the cardiac function and peripartum cardiac events in pregnant women with low-risk congenital heart disease.We performed echocardiography at early and late pregnancy and postpartum in 76 pregnant women with low-risk congenital heart disease, and compared echocardiographic parameters between subjects with and without peripartum cardiac events. Median age at delivery was 27 (range, 24-31) years. The ZAHARA and CARPREG II scores suggested that most women...
Source: International Heart Journal - Category: Cardiology Authors: Source Type: research
Abstract Pulmonary hypertension is a term used to describe a complex multifactorial group of conditions diagnosed by an elevated mean pulmonary artery pressure of 20 mm Hg or higher on right heart catheterization. The diagnosis of pulmonary hypertension in pregnancy is important, as it is associated with high rates of maternal morbidity and mortality, even with modern management. Diagnostic testing is important for establishing the diagnosis, type, and severity of pulmonary hypertension, which in turn, dictates treatment options. Echocardiographic assessment is the first step in diagnosis and the gold standard for...
Source: Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Obstet Gynecol Source Type: research
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