Pulmonary Hypertension in Pregnancy: A Case Report
Background: Pulmonary Hypertension (PH) is a disease characterized by distressing symptoms and decreased life expectancy due to the narrowing of the blood vessels of the lungs, which often leads to right heart failure. The prevalence of PH in women is 97 cases per million, with 64% of the main causes of PH in pregnancy congenital heart defects, resulting in a very high maternal and fetal mortality rate.
Case Report: A 38-year-old G4P1A2 31-week gestational age complained of shortness of breath for 5 days. Physical examination revealed blood pressure was 107/62 mmHg, Heart Rate was 98 beats per minute, respiration 40x per minute, and SpO2 88% with NRM 10 Lpm. The heart examination obtained heart sound I -II regular and a systolic murmur was heard between the left 2nd ribs. Abdominal examination was single fetus, intrauterine, breech presentation, His (+), fetal heart rate 160 beats per minute. vaginal toucher 2 cm in labour. ultrasound examination singles fetal, transverse lies, with an estimated fetal weight of 1600 grams. Echocardiography finding: ASD II L to R shunt with LV EF 60%(T), 62% (S), dilated RA-RV, TR severe, MR mild, High Probability of Pulmonary Hypertension. The patient was diagnosed with Dyspnea, Pulmonary edema caused by cardiogenic, ASD II, High probability of PH, NYHA IV, and Breech presentation in labor. Decided to perform a caesarian section and sterilization. The Male baby was born with 1570 grams Apgar Score 3-5-7. post operation patient was admitted to ICU. Twelve hours after the operation the patient had decreased control and became a PH crisis then the patient was declared dead.
Results: The death of the patient, in this case, was caused by cardiogenic shock due to Pulmonary Hypertension Crisis.
Conclusion: Early diagnosis along with collaborative and comprehensive management of pulmonary hypertension is needed for good maternal and fetal outcomes.
Keywords: pulmonary hypertension, pregnancy, heart disease.
Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Sebelas Maret University / Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126, Central Java, Indonesia. Email: firstname.lastname@example.org. Mobile: +62811294225.
Afify H, Kong A, Bernal J, Elgendy IY (2022) Pulmonary Hypertension in Pregnancy: Challenges and Solutions. Integr Blood Press Control. 15:33-41. doi: 10.2147/IBPC.S242242. PMID: 35401013; PMCID: PMC8985908.
Anjum H, Surani S (2021). Pulmonary Hypertension in Pregnancy: A Review. Medicina (B Aires). 57(3):259.
Bédard E, Dimopoulos K, Gatzoulis MA (2009). Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J. 30(3): 256-65. doi: 10.1093/eurheartj/ehn597. Epub 2009 Jan 15. PMID: 19147605.
Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, Koos BJ, Mital S (2017). Management of pregnancy in patients with complex congenital heart disease: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 135: e50–e87.
George MG, Schieb LJ, Ayala C, Talwalker A, Levant S (2010). Pulmonary hypertension surveillance. 146: 476–95.
Hemnes AR, Kiely DG, Cockrill BA, Safdar Z, Wilson VJ, Al Hazmi M, Preston IR (2015). Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute. Pulm Circ. 5: 435–465.
Kaemmerer H, Apitz C, Brockmeier K (2018). Pulmonary hypertension in adults with congenital heart disease: Update recommendations from the Cologne Consensus Conference 2018. Int J Cardiol. 272: 79-88.
Martin, Stephanie RDO, Edwards, Alexandra MD (2019). Pulmonary Hypertension and Pregnancy. Obstetrics &-amp; Gynecology 134(5): p 974-987, November 2019. doi: 10.1097/AOG.0-000000000003549.
Mayeux JD, Pan IZ, Dechand J (2021). Management of Pulmonary Arterial Hypertension. Curr Cardiovasc Risk Rep. 15(1):2.
Petersen EE, Davis NL, Goodman D, Cox S, Mayes N, Johnston E, Syverson C (2019). Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017. MMWR Morb Mortal Wkly Rep. 68(18):423-429. doi: 10.15585/mmwr.mm6818e1. PMID: 31071074; PMCID: PMC6542194.
Pieper PG, Hoendermis ES (2011). Pregnancy in women with pulmonary hypertension. Neth Heart J. 19: 504–508.
Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM (2011). ESC guidelines on the management of cardiovascular diseases during pregnancy: The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 32: 3147–97.
Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, Kells CM (2001). Cardiac Disease in Pregnancy I. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 104: 515–521.
Sliwa K, van Hagen IM, Budts W, Swan L, Sinagra G, Caruana M, Blanco MV (2016). Pulmonary hypertension and pregnancy outcomes: data from the Registry of Pregnancy and Cardiac Disease (ROPAC) of the European Society of Cardiology. Eur J Heart Fail. 18: 1119–1128.
Thomas E, Yang J, Xu J, Lima FV, Stergiopoulos K (2017). Pulmonary Hypertension and Pregnancy Outcomes: Insights from the National Inpatient Sample. Journal of the American Heart Association. 6(10): e006144. doi:10.1161/jaha.117.006144.