Pulmonary hypertension in pregnancy: Treatment with pulmonary vasodilators

Objective: To describe the clinical course of pregnancies complicated by pu lmonary hypertension and treated with the pulmonary vasodilators nifedipine and prostacyclin, Methods: Four pregnant women with pulmonary hypertension were treated with pulmonary vasodilators. Therapy with oral nifedipine and intravenous prosta cyclin was guided by right pulmonary artery catheterization and Doppler mea surements of cardiac output. Results: Three of four women responded to vasodilator therapy and successfu lly completed their pregnancies. Two who conceived at least 1 year after su ccessful treatment and normalized right ventricle function carried three un complicated pregnancies. The woman who did not respond died. Delay in diagn osis contributed to her outcome. Noninvasive measurement of cardiac output helped diagnosis of right ventricular failure and offered reassurance in wo men who remained compensated. Postpartum decompensation in one woman was ch aracterized by a negative Starling response as central venous pressure incr eased from 4 to 11 mmHg. She responded positively to diuresis. Conclusion: Early diagnosis of pulmonary hypertension is critical. Volume o verload postpartum might significantly contribute to decompensation. We rec ommend a year of successful therapy after a response to vasodilator therapy and near-normal right ventricular function before pregnancy is considered. In complicated pregnancies, women must balance the best estimate of risk w ith the value they put on pregnancy. (Obstet Gynecol 1999;93:494-8. (C) 199 9 by The American College of Obstetricians and Gynecologists.).