SUCCESSFUL PREGNANCY IN A PATIENT WITH SEVERE PULMONARY-HYPERTENSION

Pulmonary hypertension carries a grave prognosis during gestation with maternal mortality rates as high as 30-50%, even in patients with a g ood prepregnancy functional status. A case of a successfully managed p regnant woman with severe pulmonary hypertension, due to a surgically repaired atrial septal defect, is reported. She was admitted at 29 wee ks of gestation with severe dyspnea at rest, orthopnea, tachypnea, cya nosis and edema of the extremities (functional class IV). On oxygen, h er arterial blood had a pH of 7.25, an oxygen partial pressure of 60 m m Hg and a carbon dioxide partial pressure of 60 mm Hg. A continuous a nd gradual improvement of her condition was noticed with prompt therap y including bed rest, O-2 administration by face mask, digitalis, cort icosteroids and diuretics. The stabilization of her condition (functio nal class II), allowed an uneventful cesarian section at 31 weeks of g estation, under epidural anesthesia, giving birth to a premature neona te, weighing 1,600 g. The patient died 1 year later from severe cardio pulmonary insufficiency due to the gradual progression of her severe p ulmonary disease. In conclusion, prevention or interruption of pregnan cy should be recommended strongly for women with pulmonary hypertensio n. However, if a woman, despite medical advice, chooses to continue he r pregnancy, she can benefit from a prompt and well-balanced managemen t, even in the presence of severe impairment of her functional status.