Pulmonary hypertension complicating systemic sclerosis: A successful pregnancy outcome

Reproductive Issues and Pregnancy Implications in Systemic Sclerosis

Systemic sclerosis (SSc) is a rare systemic autoimmune disease that can influence reproductive health. SSc has a strong female predominance, and the disease onset can occur during fertility age in almost 50% of patients. Preconception counseling, adjustment of treatment, and close surveillance during pregnancy by a multidisciplinary team, are key points to minimize fetal and maternal risks and favor successful pregnancy outcomes. The rates of spontaneous pregnancy losses are comparable to those of the general obstetric population, except for patients with diffuse cutaneous SSc and severe internal organ involvement who may carry a higher risk of abortion. Preterm birth can frequently occur in women with SSc, as it happens in other rheumatic diseases. Overall disease activity generally remains stable during pregnancy, but particular attention should be paid to women with major organ disease, such as renal and cardiopulmonary involvement. Women with such severe involvement should be thoroughly informed about the risks during pregnancy and possibly discouraged from getting pregnant. A high frequency of sexual dysfunction has been described among SSc patients, both in females and in males, and pathogenic mechanisms of SSc may play a fundamental role in determining this impairment. Fertility is overall normal in SSc women, while no studies in the literature have investigated fertility in SSc male patients. Nevertheless, some considerations regarding the impact of some immunosuppressive drugs should be done with male patients, referring to the knowledge gained in other rheumatic diseases.

Obstetric outcomes in pregnancy with pulmonary hypertension: A retrospective study of 78 cases at one center

OBJECTIVE

To identify the vary of obstetric outcomes by the severity of pulmonary hypertension (PH).

METHODS

A retrospective study involved pregnancies with PH in one certain academic institution. Total 78 pregnancies with PH were classified into three groups according the mean pulmonary arterial systolic pressure: mean pulmonary arterial systolic pressure 30-49 mm Hg (mild-PH group), mean pulmonary arterial systolic pressure 50-69 mm Hg (moderate-PH group) and mean pulmonary arterial systolic pressure ≥ 70 mm Hg (severe-PH group). The clinical features and obstetric outcomes were described and compared among three groups.

RESULTS

The incidence of PH was 0.23%, including 57 cases in mild-PH group, 10 cases in moderate-PH group and 11 cases in severe-PH group. Meanwhile, pregnancies with mild PH present NYHA class I/II (P < 0.001). General anesthesia (P < 0.001) and advanced intensive care (P = 0.011) were supplied for pregnancies with severe PH. There was no significant difference in rate of caesarean delivery. Furthermore, severity of PH increased the risk of neonatal death (P = 0.040).

CONCLUSION

The severity of PH seems to be a poor prognosis of neonatal death. Intensive care should be provided for pregnancies with severe PH.