Primary pulmonary hypertension in pregnancy; a role for novel vasodilators

We describe the case of a 28-week pregnant woman presenting with severe pri mary pulmonary hypertension (PPH). She had an elective Caesarean section un der general anaesthesia at 32 weeks gestation. Pulmonary artery pressures ( PAP) measured from a pulmonary artery catheter before anaesthesia were in e xcess of 100 mm Hg. Intraoperative nitric oxide was used to reduce PAP. Aft er the delivery of a healthy infant PAP was controlled with nebulized ilopr ost and a prostacyclin infusion. Seven days later she was discharged from i ntensive care taking an oral calcium antagonist and warfarin. She developed intractable right heart failure and died 14 days after delivery. Despite i ncreasing experience in the use of drugs to reduce PAP, the clinical course of pregnancy complicated by severe PPH is usually fatal.