PULMONARY-HYPERTENSION AND PREGNANCY - A SERIES OF 8 CASES

This is the report of a series of eight patients with pulmonary hypert ension (primary and secondary) who delivered at the McMaster Universit y Medical Centre between 1978 and 1987. Seven of the eight patients de livered vaginally and had a successful outcome. The eighth patient was admitted as an emergency and died shortly after Caesarean section und er general anaesthesia, performed to save the infant. The other seven patients were all managed by a team, including anaesthetists, cardiolo gists and obstetricians, from about 25 wk. The patients were hospitali zed pre-partum and received oxygen therapy and anticoagulation with he parin. Analgesia in labour was managed, once anticoagulation was rever sed, by low concentrations of epidural bupivacaine (0.125%-0.375%) and fentanyl. The patients were monitored during labour and delivery with oximetry and arterial and central venous pressure lines. Pulmonary ar terial lines were not used because of increased risk and questionable usefulness. Vaginal delivery was managed with vacuum extraction or for ceps lift-out to minimize the stress of pushing. After delivery, all p atients were monitored in an intensive care unit for several days, ant icoagulation was restarted and all patients were discharged home takin g oral anticoagulant therapy. The successful management of pulmonary h ypertension in pregnancy should include team management started early in pregnancy and controlled vaginal delivery utilizing epidural analge sia.