Pregnancy and heart disease pulmonary hypertension: Difference between revisions
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Pulmonary hypertension, defined as mean pulmonary artery pressure of greater than 25 mmHg at rest or 30 mmHg with exercise, carries a higher mortality when it is associated with pregnancy. It carries a significant risk to mother and child during pregnancy; as a result, mothers require careful monitoring.<ref name="pmid19223169">{{cite journal| author=Madden BP| title=Pulmonary hypertension and pregnancy. | journal=Int J Obstet Anesth | year= 2009 | volume= 18 | issue= 2 | pages= 156-64 | pmid=19223169 | doi=10.1016/j.ijoa.2008.10.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19223169 }} </ref> | Pulmonary hypertension, defined as mean pulmonary artery pressure of greater than 25 mmHg at rest or 30 mmHg with exercise, carries a higher mortality when it is associated with pregnancy. It carries a significant risk to mother and child during pregnancy; as a result, mothers require careful monitoring.<ref name="pmid19223169">{{cite journal| author=Madden BP| title=Pulmonary hypertension and pregnancy. | journal=Int J Obstet Anesth | year= 2009 | volume= 18 | issue= 2 | pages= 156-64 | pmid=19223169 | doi=10.1016/j.ijoa.2008.10.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19223169 }} </ref> | ||
==[[Pulmonary hypertension classifications|Classification]]== | |||
==Physiologic Considerations in Pregnancy== | |||
As reviewed in [[Pregnancy and heart disease pathophysiology||Physiologic Changes Associated with Pregnancy]], maternal blood volume increases throughout pregnancy until between 28 and 34 weeks of gestation, and circulating blood volume is increased to between 30% and 50% above the non-pregnant state. Red blood cell mass increases to approximately 25% above the non-pregnant state. Cardiac output increases through various mechanisms, and hyper coagulability is noted in the postpartum state due to relative resistance to activated protein C, reduced serum levels of protein S and increased levels of factors I, II V, VII, VIII, X and XII.<ref name="pmid14484810">{{cite journal| author=PECHET L, ALEXANDER B| title=Increased clotting factors in pregnacy. | journal=N Engl J Med | year= 1961 | volume= 265 | issue= | pages= 1093-7 | pmid=14484810 | doi=10.1056/NEJM196111302652205 | pmc= | url= }} </ref> | |||
All of these changes can be particularly deleterious in patients with PAH. It can be very harmful if a thrombus forms or embolises to an already compromised pulmonary circulation. Such hematological changes present a significant risk, and mortality fall between 30% and 50% for pregnant women with idiopathic PAH.<ref name="pmid9626847">{{cite journal| author=Weiss BM, Zemp L, Seifert B, Hess OM| title=Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. | journal=J Am Coll Cardiol | year= 1998 | volume= 31 | issue= 7 | pages= 1650-7 | pmid=9626847 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9626847 }} </ref> | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Anjan K. Chakrabarti, M.D. [2]
Overview
This section will review pulmonary hypertension and its association with pregnancy. For a more broad discussion, please see pulmonary hypertension.
Pulmonary hypertension, defined as mean pulmonary artery pressure of greater than 25 mmHg at rest or 30 mmHg with exercise, carries a higher mortality when it is associated with pregnancy. It carries a significant risk to mother and child during pregnancy; as a result, mothers require careful monitoring.[1]
Classification
Physiologic Considerations in Pregnancy
As reviewed in |Physiologic Changes Associated with Pregnancy, maternal blood volume increases throughout pregnancy until between 28 and 34 weeks of gestation, and circulating blood volume is increased to between 30% and 50% above the non-pregnant state. Red blood cell mass increases to approximately 25% above the non-pregnant state. Cardiac output increases through various mechanisms, and hyper coagulability is noted in the postpartum state due to relative resistance to activated protein C, reduced serum levels of protein S and increased levels of factors I, II V, VII, VIII, X and XII.[2]
All of these changes can be particularly deleterious in patients with PAH. It can be very harmful if a thrombus forms or embolises to an already compromised pulmonary circulation. Such hematological changes present a significant risk, and mortality fall between 30% and 50% for pregnant women with idiopathic PAH.[3]
References
- ↑ Madden BP (2009). "Pulmonary hypertension and pregnancy". Int J Obstet Anesth. 18 (2): 156–64. doi:10.1016/j.ijoa.2008.10.006. PMID 19223169.
- ↑ PECHET L, ALEXANDER B (1961). "Increased clotting factors in pregnacy". N Engl J Med. 265: 1093–7. doi:10.1056/NEJM196111302652205. PMID 14484810.
- ↑ Weiss BM, Zemp L, Seifert B, Hess OM (1998). "Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996". J Am Coll Cardiol. 31 (7): 1650–7. PMID 9626847.