Maternal Outcome in Pregnancy Complicated With Pulmonary Arterial Hypertension

被引:62
作者
Katsuragi, Shinji [1 ]
Yamanaka, Kaoru [1 ]
Neki, Reiko [1 ]
Kamiya, Chizuko [1 ]
Sasaki, Yoshihito [1 ]
Osato, Kazuhiro [1 ]
Miyoshi, Takekazu [1 ]
Kawasaki, Kaoru [1 ]
Horiuchi, Chinami [1 ]
Kobayashi, Yoshinari [1 ]
Ueda, Keiko [1 ]
Yoshimatsu, Jun [1 ]
Niwa, Koichiro [2 ]
Takagi, Yaemi [3 ]
Ogo, Takeshi [3 ]
Nakanishi, Norifumi [3 ]
Ikeda, Tomoaki [1 ]
机构
[1] Natl Cerebral & Cardiovasc Ctr, Dept Perinatol & Gynecol, Suita, Osaka 5658565, Japan
[2] St Lukes Int Hosp, Dept Cardiol, Tokyo, Japan
[3] Pulm Circulat Grp, Dept Cardiovasc Med, Suita, Osaka, Japan
关键词
Eisenmenger syndrome; Pregnancy; Pulmonary arterial hypertension; CONNECTIVE-TISSUE DISEASE; CONGENITAL HEART-DISEASE; VASCULAR-DISEASE; IMMUNOSUPPRESSIVE THERAPY; SILDENAFIL; ECHOCARDIOGRAPHY; GUIDELINES; MANAGEMENT; PROGRESS;
D O I
10.1253/circj.CJ-12-0235
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Pulmonary arterial hypertension (PAH), including Eisenmenger syndrome, has a risk of mortality in pregnancy of 10-40%. The aim of this study was to investigate whether pulmonary artery blood pressure (PABP) is a prognostic factor for pregnancy outcome in patients with PAH. Methods and Results: The subjects were 42 patients with PAH during pregnancy. Severe and mild cases were defined by PABP before and during the first 14 weeks of pregnancy, with severe cases having mean PABP >40 mmHg by catheterization or systolic PABP >50 mmHg on echocardiography. Eighteen women chose termination of pregnancy before 14 weeks, leaving 24 women (10 mild, 14 severe) for analysis. The women with severe PAH delivered earlier (35.4 vs. 31.5 weeks, P<0.05) and had higher rates of small-for-gestational-age infants (0/10 vs. 7/14, P<0.01). Among the women with severe PAH, the New York Heart Association class dropped by 1 in 9 cases, by 2 in 3 cases, and remained the same in 2 cases as pregnancy progressed, whereas among the women with mild PAH, the class dropped by 1 in 1 case and 9 women remained in the same class. Among the severe cases, 1 woman died and there was 1 fetal death; PABP markedly increased in later pregnancy from 54 to 74 mmHg (catheter measurement) and from 78 to 93 mmHg (echocardiography) (P<0.05). Conclusions: The level of PABP before or in the early stage of pregnancy is an important predictor of pregnancy outcome. (Circ J 2012; 76: 2249-2254)
引用
收藏
页码:2249 / 2254
页数:6
相关论文
共 36 条
[1]  
[Anonymous], 1994, Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels
[2]   Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? [J].
Bedard, Elisabeth ;
Dimopoulos, Konstantinos ;
Gatzoulis, Michael A. .
EUROPEAN HEART JOURNAL, 2009, 30 (03) :256-265
[3]   Pregnancy outcome in patients with pulmonary arterial hypertension receiving prostacyclin therapy [J].
Bendayan, D ;
Hod, M ;
Oron, G ;
Sagie, A ;
Eidelman, L ;
Shitrit, D ;
Kramer, MR .
OBSTETRICS AND GYNECOLOGY, 2005, 106 (05) :1206-1210
[4]  
Casserly B, 2009, DRUG DES DEV THER, V3, P269
[5]   PRIMARY PULMONARY-HYPERTENSION AND PREGNANCY [J].
DAWKINS, KD ;
BURKE, CM ;
BILLINGHAM, ME ;
JAMIESON, SW .
CHEST, 1986, 89 (03) :383-388
[6]   Familial primary pulmonary hypertension (gene PPH1) is caused by mutations in the bone morphogenetic protein receptor-II gene [J].
Deng, ZM ;
Morse, JH ;
Slager, SL ;
Cuervo, N ;
Moore, KJ ;
Venetos, G ;
Kalachikov, S ;
Cayanis, E ;
Fischer, SG ;
Barst, RJ ;
Hodge, SE ;
Knowles, JA .
AMERICAN JOURNAL OF HUMAN GENETICS, 2000, 67 (03) :737-744
[7]   Pulmonary vascular disease in adults with congenital heart disease [J].
Diller, Gerhard-Paul ;
Gatzoulis, Michael A. .
CIRCULATION, 2007, 115 (08) :1039-1050
[8]   Pulmonary hypertension in pregnancy: Treatment with pulmonary vasodilators [J].
Easterling, TR ;
Ralph, DD ;
Schmucker, BC .
OBSTETRICS AND GYNECOLOGY, 1999, 93 (04) :494-498
[9]   The use of iloprost in early pregnancy in patients with pulmonary arterial hypertension [J].
Elliot, CA ;
Stewart, P ;
Webster, VJ ;
Mills, GH ;
Hutchinson, SP ;
Howarth, ES ;
Bu'Lock, FA ;
Lawson, RA ;
Armstrong, IJ ;
Kiely, DG .
EUROPEAN RESPIRATORY JOURNAL, 2005, 26 (01) :168-173
[10]   Clinical classification of pulmonary hypertension [J].
Fishman, AP .
CLINICS IN CHEST MEDICINE, 2001, 22 (03) :385-+