OUTCOME OF PULMONARY VASCULAR-DISEASE IN PREGNANCY - A SYSTEMATIC OVERVIEW FROM 1978 THROUGH 1996

Objectives. Published reports were reviewed to evaluate the characteri stics of peripartal management: and the Bate pregnancy outcome in wome n with pulmonary vascular disease (PVD). Background. Pulmonary hyperte nsion poses one of the highest risks for maternal mortality, but actua l data on the maternal and neonatal prognosis in this group are lackin g. Methods. Reports published from 1978 through 1996 of Eisenmenger's syndrome (n = 73), primary pulmonary hypertension (PPH) (n = 27) and s econdary vascular pulmonary hypertension (SVPH) (n = 25) complicating late pregnancy mere included and analyzed using logistic regression an alysis. Results. Maternal mortality was 36% in Eisenmenger's syndrome, 30% in PPH and 56% (p < 0.08 vs. other two groups) in SVPH. Except fo r three prepartal deaths due to Eisenmenger's syndrome, all fatalities occurred within 35 days after delivery. Neonatal survival ranging fro m 87% to 89% was similar in the three groups. Previous pregnancies, ti ming of the diagnosis and hospital admission, operative delivery and d iastolic pulmonary artery pressure were significant univariate (p < 0. 05) maternal risk factors. Late diagnosis (p = 0.002, odds ratio 5.4) and late hospital admission (p = 0.01, odds ratio 1.1 per week of preg nancy) were independent predictive risk factors of maternal mortality. Conclusions. In the last two decades maternal mortality was comparabl e in patients with Eisenmenger's syndrome and PPH; however, it was rel evantly higher in SVPH. Maternal prognosis depends on the early diagno sis of PVD, early hospital admission, individually tailored treatment during pregnancy and medical therapy and care focused on the postparta l period. (C) 1998 by the American College of Cardiology.