Abstract:
Introduction : Primary Pulmonary Hypertension
(PPH) in pregnancy is "associated with a high
maternal mortality. Eisenmenger's Syndrome in
pregnancy has a reported incidence of maternal
mortality of 52%. Fourteen patients with severe
pulmonary hypertension complicating pregnancy who
were manased by the University Obstetrics Unit.
Colombo are descnbecL Methodology : Five patients with PPH were refered
'o us at an average POG of 22 weeks. Four were
diagnosed during the antenatal period, while one was
transferred in her second pregnancy for suspected
cervical incompetence. The latter been diagnosed
to have PPH during her first pregnancy the year
before!
Six patients had Eisenmenger's Syndrome; four had
atrial septal defect (one in her 7th pregnancy) and 2
had ventricular septal defect.
Two patients had Cor Pulmonale and one had Obesity
- Hypoventilation Syndrome.
A ll patients were kept "in - ward" throughout
pregnancy with oxygen inhalation, bed rest,
subcutaneous heparin and frequent cardiovascular
monitoring.
Termination of pregnancy by Caesarean Section was
considered at 35 weeks'POG or earlier if cardiac
decompensation occurred.
Results : All those with PPH were terminated at 35
weeks POG by elective lower segment caesarean
section and sterilized ( 3 under local anesthesia and
2 under epidural anaesthesia). Three of these women
succumbed within 48 hour of delivery.
Of those with Eisenmenger's Syndrome, 3 underwent
elective caesarean section at 36 weeks of whom one
succumbed at 3 weeks post partum. One had a death
-in - utero at 32 weeks. Two were terminated at
mid-trimester by hysterotomy due to cardiac
decompensation and succumbed 24 hours po§t
delivery. Of those with Cor Pulmonale one had
respiratory arrest with the onset of labour at 33 weeks.
The other needed termination at 29 weeks and died
36 hours post delivery. The patient with ObesityHypoventilation was terminated at 26 weeks and
survived upto 5 months post partum when she died
of secondary respiratory failure.
The eight maternal deaths described contributed to
the total of 11 maternal deaths in our unit during this
period.
Conclusion : Pulmonary Hypertension in pregnancy
has a high risk of liMttiual and fetal death and should
be avoided whenever possible by pre-conception
counselling and termination in early pregnancy.