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Lv C, Huang Y, Liao G, Wu L, Chen D, Gao Y. Pregnancy outcomes in women with pulmonary hypertension: a retrospective study in China. BMC Pregnancy Childbirth 2023; 23:16. [PMID: 36624418 PMCID: PMC9830858 DOI: 10.1186/s12884-023-05353-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In recent years, with the development of monitoring conditions and the application of pulmonary vascular-targeted drugs, pregnancy outcomes in women with pulmonary hypertension (PH) have improved, but the maternal mortality rate is still high. The purpose of this study was to describe the maternal-foetal outcomes in pregnant women with PH. METHODS The clinical data of 154 pregnant women with PH who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 2011 to December 2020 were collected and descriptively analysed. RESULTS Among the 154 pregnant women with PH, 6 (3.9%) had idiopathic pulmonary arterial hypertension (iPAH), 41 (26.6%) had pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH), 45 (29.2%) had PAH related to other diseases (oPAH), and 62 (40.3%) had PH related to left heart disease (LHD-PH). The systolic pulmonary artery pressure (sPAP) was 36-49 mmHg in 53.2% of the patients, 50-69 mmHg in 22.1% of the patients and ≥ 70 mmHg in 24.7% of the patients. Five (3.2%) pregnant women died within 1 week after delivery; iPAH patients had the highest mortality rate (3/6, 50%). Fifty-four patients (35.1%) were admitted to the intensive care unit (ICU), and the incidence of heart failure during pregnancy was 14.9%. A total of 70.1% of the patients underwent caesarean section; 42.9% had premature infants; 28.6% had low-birth-weight (LBW) infants; 13.0% had very-low-birth-weight (VLBW) infants; 3.2% had extremely-low-birth-weight (ELBW) infants; 61% had small for gestational age (SGA) infants; and 1.9% experienced neonatal mortality. CONCLUSION There were significant differences in the maternal-foetal outcomes in the iPAH, CHD-PAH, oPAH and LHD-PH groups. Maternal mortality was highest in the iPAH group; therefore, iPAH patients should be advised to prevent pregnancy. Standardized and multidiscipline-assisted maternal management is the key to improving maternal-foetal outcomes.
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Affiliation(s)
- Chengtian Lv
- grid.417009.b0000 0004 1758 4591Department of Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuwen Huang
- grid.417009.b0000 0004 1758 4591Department of Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guangyuan Liao
- grid.417009.b0000 0004 1758 4591Department of Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lichan Wu
- grid.417009.b0000 0004 1758 4591Department of Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dunjin Chen
- grid.417009.b0000 0004 1758 4591Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanmei Gao
- grid.417009.b0000 0004 1758 4591Department of Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Liu Y, Li Y, Zhang J, Zhang D, Li J, Zhao Y, Liu K, Ma X, Bai C, Gu H, Fan X, Wang J. Maternal and fetal outcomes of pregnant women with pulmonary arterial hypertension associated with congenital heart disease in Beijing, China: a retrospective study. Pulm Circ 2022; 12:e12079. [PMID: 35514772 PMCID: PMC9063973 DOI: 10.1002/pul2.12079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/11/2022] Open
Abstract
As pulmonary arterial hypertension associated with congenital heart disease (PAH‐CHD) may increase maternal and fetal risk, this study explored the pregnancy outcomes of Chinese women with PAH‐CHD. The clinical data of pregnant women with PAH‐CHD admitted to the Beijing Anzhen Hospital from 2010 to 2019 were retrospectively analyzed; these patients and their offspring were followed up, with a mean period of 5.9 ± 2.7 years. Overall, 260 patients with PAH‐CHD were included. The mean maternal age was 27.7 ± 4.1 years, and 205 (78.8%) patients were nulliparous. The estimated systolic pulmonary artery pressure was 40–50 mmHg in 34.6% of the patients, 50–70 mmHg in 23.1%, and >70 mmHg in 42.3%. More than 96% of patients were diagnosed with PAH‐CHD before pregnancy. During pregnancy, heart failure occurred in 19.2% of the patients. Cesarean delivery was performed in 88.1% (15.0% emergency) of the patients. Complications included fetal distress (5.8%), preterm delivery (34.2%), and low birth weight (33.8%). A total of 15 mothers (5.8%) died, with the highest mortality rate in those with Eisenmenger syndrome (10/43, 23.3%), and 10 offspring died (3.8%), two (0.8%) following hospital discharge and eight (3.1%) while in hospital. Although most pregnant women with PAH‐CHD were able to have children, PAH increased the maternal and fetal risk. Thus, an individualized risk‐based approach with shared decision‐making may be more appropriate in pregnant women with PAH‐CHD.
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Affiliation(s)
- Yang Liu
- Department of Pediatric Cardiac Center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Yanna Li
- Department of Obstetrics and Gynecology Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Jun Zhang
- Department of Obstetrics and Gynecology Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Dawei Zhang
- Department of Obstetrics and Gynecology Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Jiachen Li
- Department of Pediatric Cardiac Center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Yichen Zhao
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Kemin Liu
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Xiaolong Ma
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Chen Bai
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Hong Gu
- Department of Pediatric Cardiac Center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Xiangming Fan
- Department of Pediatric Cardiac Center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
| | - Jiangang Wang
- Department of Valvular Cardiac surgery center Beijing Anzhen Hospital affiliated to Capital Medical University No 2 Anzhen Road Chaoyang District, Beijing China
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Effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension: a meta-analysis. Arch Gynecol Obstet 2021; 306:7-15. [DOI: 10.1007/s00404-021-06274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
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Dias A, Mineiro A, Pinto L, Lança F, Plácido R, Lousada N. Pregnancy and Pulmonary Arterial Hypertension: A Case Report. OPEN RESPIRATORY ARCHIVES 2021. [PMID: 37496839 PMCID: PMC10369517 DOI: 10.1016/j.opresp.2021.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Han R, Gao L, Sun H, Li M, Deng C. Effect of Yiqi Buxue Decoction on Hemodynamic Changes of the Uterine Artery and Fetal Umbilical Artery and Pregnancy Outcomes in Pregnant Patients with Pulmonary Arterial Hypertension. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:1849114. [PMID: 34457018 PMCID: PMC8387161 DOI: 10.1155/2021/1849114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the effect of Yiqi Buxue decoction on hemodynamic changes of the uterine artery and fetal umbilical artery and pregnancy outcomes in pregnant patients with pulmonary arterial hypertension (PAH). METHODS 120 pregnant patients with PAH treated in our hospital (January 2019-January 2020) were chosen as the research objects, and randomly split into group A (n = 60) and group B (n = 60). Both groups received routine treatment, and group B was treated with sildenafil citrate, while group A was treated with Yiqi Buxue decoction combined with sildenafil citrate. Both groups received 6 weeks of treatment to analyze the hemodynamic changes of the uterine artery and fetal umbilical artery and compare the cardiopulmonary function indexes and pregnancy outcomes between the two groups. RESULTS The hemodynamic indexes of the uterine artery and fetal umbilical artery, cardiopulmonary function indexes, and pregnancy outcomes in group A after treatment were notably better compared with group B (P < 0.01). CONCLUSION Yiqi Buxue decoction can stabilize the hemodynamics of pregnant patients with PAH, improve their cardiopulmonary function, alleviate hypotension, and thus, reduce the possibility of adverse pregnancy outcomes, which should be popularized in practice.
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Affiliation(s)
- Rendong Han
- Department of Obstetrics, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Liya Gao
- Department of Gynecology and Obstetrics, Beijing ChuiYangLiu Hospital, Beijing 100022, China
| | - Hongbo Sun
- Department of Gynecology and Obstetrics, Beijing ChuiYangLiu Hospital, Beijing 100022, China
| | - Mei Li
- Department of Gynecology and Obstetrics, Beijing ChuiYangLiu Hospital, Beijing 100022, China
| | - Chunxia Deng
- Department of Gynecology and Obstetrics, Beijing ChuiYangLiu Hospital, Beijing 100022, China
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Corbach N, Berlier C, Lichtblau M, Schwarz EI, Gautschi F, Groth A, Schüpbach R, Krähenmann F, Saxer S, Ulrich S. Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension. Front Med (Lausanne) 2021; 8:689764. [PMID: 34291063 PMCID: PMC8287120 DOI: 10.3389/fmed.2021.689764] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/10/2021] [Indexed: 01/31/2023] Open
Abstract
Introduction: Since pregnancy in women with pulmonary arterial hypertension (PAH) is associated with a high risk of morbidity and mortality, it is recommended that pregnancy should be avoided in PAH. However, some women with mild PAH may consider this recommendation as unsuitable. Unfortunately knowledge on pregnancy outcomes and best management of PAH during pregnancy is limited. Methods: Data from all women with PAH who were followed during pregnancy by a multidisciplinary team at a tertiary referral center for PAH and who delivered between 2004 and 2020 were retrospectively analyzed in a case series. PAH risk factor profiles including WHO functional class (WHO-FC), NT-pro-BNP, echocardiographic pulmonary arterial pressure (PAP) and right heart function were analyzed prior to, during and following pregnancy. Results: In seven pregnancies of five women with PAH (median age 29 (27; 31) years), there were no abortions or terminations. Five pregnancies were planned (all in WHO-FC I-II), two incidental (WHO-FC II, III). During pregnancy none of the women had complications or clinical worsening of PAH. After a median pregnancy duration of 37 1/7 weeks all gave birth to healthy babies by cesarean section in spinal anesthesia. During pregnancy, PAP tended to increase, whilst the course of WHO-FC and NT-pro-BNP were variable and no trend could be detected. Conclusion: Women with PAH with a low risk profile closely followed by a multidisciplinary team had a favorable course during and after pregnancy, resulting in successful deliveries of healthy newborns.
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Affiliation(s)
- Nadine Corbach
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Charlotte Berlier
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Fiorenza Gautschi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Groth
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Schüpbach
- Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Stéphanie Saxer
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Yang JZ, Fernandes TM, Kim NH, Poch DS, Kerr KM, Lombardi S, Melber D, Kelly T, Papamatheakis DG. Pregnancy and pulmonary arterial hypertension: a case series and literature review. Am J Obstet Gynecol MFM 2021; 3:100358. [PMID: 33785463 DOI: 10.1016/j.ajogmf.2021.100358] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite the development of advanced therapies for pulmonary arterial hypertension, pregnancy remains contraindicated in these patients owing to high maternal and fetal morbidity and mortality. Limited data exist regarding pregnancy management and outcome in this unique patient population. We describe a series of pregnant patients diagnosed as having pulmonary arterial hypertension before or during pregnancy who delivered at a tertiary center with a comprehensive and established pulmonary vascular disease program. OBJECTIVE This study aimed to describe a single institution's experience and review the existing literature for pregnancy management and outcomes in patients with pulmonary arterial hypertension. STUDY DESIGN A review of all patients with pulmonary arterial hypertension who were admitted for delivery between 2005 and 2019 at our institution was performed. All data were extracted from the electronic health record and included patient demographics, pulmonary arterial hypertension subtype, pulmonary arterial hypertension-targeted therapies, and mode of delivery and anesthesia. RESULTS A total of 7 patients were identified; 5 patients had a prepartum diagnosis of pulmonary arterial hypertension, whereas 2 patients were diagnosed as having pulmonary arterial hypertension during the third trimester. All patients were started on prostacyclins and the majority were on combination pulmonary arterial hypertension-targeted therapy. The maternal mortality rate was 29%. Elective cesarean delivery was performed in more than 70% of cases, whereas 1 patient required an urgent cesarean delivery and 1 patient had a successful vaginal delivery. Most patients had epidural anesthesia. Notably, 2 patients required extracorporeal membrane oxygenation after delivery and both died. There were no cases of neonatal mortality. CONCLUSION Our cases series and the published literature to date show that pregnancy in pulmonary arterial hypertension remains poorly tolerated despite marked advancements in pulmonary arterial hypertension-targeted therapies and postpartum care. A multidisciplinary team approach remains essential for the management of these patients.
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Affiliation(s)
- Jenny Z Yang
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Drs Yang, Fernandes, Kim, Poch, and Kerr; Ms Lombardi; and Dr Papamatheakis).
| | - Timothy M Fernandes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Drs Yang, Fernandes, Kim, Poch, and Kerr; Ms Lombardi; and Dr Papamatheakis)
| | - Nick H Kim
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Drs Yang, Fernandes, Kim, Poch, and Kerr; Ms Lombardi; and Dr Papamatheakis)
| | - David S Poch
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Drs Yang, Fernandes, Kim, Poch, and Kerr; Ms Lombardi; and Dr Papamatheakis)
| | - Kim M Kerr
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Drs Yang, Fernandes, Kim, Poch, and Kerr; Ms Lombardi; and Dr Papamatheakis)
| | - Sandra Lombardi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Drs Yang, Fernandes, Kim, Poch, and Kerr; Ms Lombardi; and Dr Papamatheakis)
| | - Dora Melber
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Melber and Kelly), University of California, San Diego, La Jolla, CA
| | - Thomas Kelly
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences (Drs Melber and Kelly), University of California, San Diego, La Jolla, CA
| | - Demosthenes G Papamatheakis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Drs Yang, Fernandes, Kim, Poch, and Kerr; Ms Lombardi; and Dr Papamatheakis)
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Zhao A, Qi Y, Liu K. CLDN3 expression and function in pregnancy-induced hypertension. Exp Ther Med 2020; 20:3798-3806. [PMID: 32855729 PMCID: PMC7444375 DOI: 10.3892/etm.2020.9084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
This aim of the present study was to investigate the expression and function of claudin 3 (CLDN3) in pregnancy-induced hypertension. The mRNA expression levels of CLDN3 in the placental tissue and peripheral blood of patients with pregnancy-induced hypertension were measured using reverse transcription-quantitative PCR. Human trophoblast HTR8/SVneo cells overexpressing CLDN3 were generated using a lentiviral vector. Cell Counting kit-8 (CCK-8) assay, flow cytometry, Transwell chamber assays, confocal laser scanning microscopy and western blot analysis were performed to detect cell proliferation, invasion, migration and apoptosis, in addition to matrix metalloproteinase (MMP) expression and ERK1/2 phosphorylation. The mRNA expression levels of CLDN3 were significantly reduced in the placental tissues and peripheral blood samples of patients with pregnancy-induced hypertension compared with healthy pregnant controls. CLDN3 overexpression significantly increased HTR8/SVneo cell proliferation, invasion and migration whilst reducing apoptosis. HTR8/SVneo cells overexpressing CLDN3 also exhibited increased myofiber levels, increased MMP-2 and MMP-9 expression and increased ERK1/2 signaling activity. CLDN3 downregulation may be associated with the pathogenesis of pregnancy-induced hypertension. In conclusion, CLDN3 promotes the proliferative and invasive capabilities of human trophoblast cells, with the underlying mechanisms possibly involving upregulation of MMP expression via the ERK1/2 signaling pathway.
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Affiliation(s)
- Aixin Zhao
- Department of Obstetrics, Laiwu Maternal and Child Health Hospital, Laiwu, Shandong 271199, P.R. China
| | - Yunfang Qi
- Department of Obstetrics, Laiwu Maternal and Child Health Hospital, Laiwu, Shandong 271199, P.R. China
| | - Kun Liu
- Department of Obstetrics, Laiwu Maternal and Child Health Hospital, Laiwu, Shandong 271199, P.R. China
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Jaén-Vento L, Buenrostro-Badillo A, Macías-Amezcua M. Hipertensión arterial pulmonar presentada en el puerperio. Reporte de caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2019. [DOI: 10.1016/j.gine.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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