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AJP Rep 2013; 03(02): 071-074
DOI: 10.1055/s-0033-1338169
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intravenous Epoprostenol for Management of Pulmonary Arterial Hypertension during Pregnancy

Julia Timofeev
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, MedStar Health, Washington, District of Columbia
,
George Ruiz
2   Department of Cardiology, MedStar Washington Hospital Center, MedStar Health, Washington, District of Columbia
,
Melissa Fries
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, MedStar Health, Washington, District of Columbia
,
Rita W. Driggers
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, MedStar Health, Washington, District of Columbia
› Author Affiliations
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Publication History

21 December 2012

02 February 2013

Publication Date:
18 March 2013 (online)

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Abstract

Background Pulmonary arterial hypertension carries a high risk of mortality in pregnancy. Recent advances in treatment may improve disease course and allow for successful management of the pregnancy.

Case Report We present the case of a 20-year-old gravida 1, para 0 with diagnosis of severe primary pulmonary hypertension. The patient was managed with epoprostenol (prostacyclin) infusion via an indwelling catheter, which was initiated at 23 weeks' gestation. The dose was adjusted to the patient's symptoms and a successful vaginal delivery was achieved at 36 weeks' gestation. Although maternal postpartum course was uncomplicated, unexplained neonatal demise occurred at 11 days of life.

Conclusion Successful management of pulmonary hypertension in pregnancy can be accomplished with a multidisciplinary approach and intensive therapy. Long-term effects of epoprostenol on fetal or neonatal well-being are unknown.

Keywords

epoprostenol - pulmonary hypertension - prostaglandin - prostacyclin
 

  • References

  • 1 Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol 1998; 31: 1650-1657
    CrossrefPubMedGoogle Scholar
  • 2 Madden BP. Pulmonary hypertension and pregnancy. Int J Obstet Anesth 2009; 18: 156-164
    CrossrefPubMedGoogle Scholar
  • 3 Humbert M, Sitbon O, Simonneau G. Treatment of pulmonary arterial hypertension. N Engl J Med 2004; 351: 1425-1436
    CrossrefPubMedGoogle Scholar
  • 4 Bendayan D, Hod M, Oron G , et al. Pregnancy outcome in patients with pulmonary arterial hypertension receiving prostacyclin therapy. Obstet Gynecol 2005; 106 (5 Pt 2) 1206-1210
    CrossrefPubMedGoogle Scholar
  • 5 Bildirici I, Shumway JB. Intravenous and inhaled epoprostenol for primary pulmonary hypertension during pregnancy and delivery. Obstet Gynecol 2004; 103 (5 Pt 2) 1102-1105
    CrossrefPubMedGoogle Scholar
  • 6 Avdalovic M, Sandrock C, Hoso A, Allen R, Albertson TE. Epoprostenol in pregnant patients with secondary pulmonary hypertension: two case reports and a review of the literature. Treat Respir Med 2004; 3: 29-34
    CrossrefPubMedGoogle Scholar
  • 7 Bédard E, Dimopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension?. Eur Heart J 2009; 30: 256-265
    PubMedGoogle Scholar
  • 8 Parisi VM, Walsh SW. Fetal vascular responses to prostacyclin. Am J Obstet Gynecol 1989; 160: 871-876 , discussion 876–878
    CrossrefPubMedGoogle Scholar