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Title PULMONARY ARTERIAL HYPERTENSION AND PREGNANCY - A SYSTEMATIC REVIEW OF PREGNANCY OUTCOMES IN A CONTEMPORARY COHORT |
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Type Free Paper Session 3 |
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Theme ACC Asia & SCS 32nd Annual Scientific Meeting |
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Topic Non-Invasive Cardiac Imaging, Echocardiography, Nuclear Cardiology / Adult Congenital Heart Disease / Cardiac Surgery |
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Main Author Laureen Wang1 |
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Presenting Author Laureen Wang1 |
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Co-Author Ting Ting Low1 Nita Guron2 Candice Silversides2 |
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Department / Institution / Country Cardiology / National University Hospital / Singapore1 Cardiology / Toronto General Hospital / Canada2 |
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Objective(s) To perform a systematic review of adverse pregnancy outcomes in pregnant women with PAH in the last decade. |
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Material and Method We searched Medline, Embase and Cochrane database for articles describing outcomes in pregnancy published in 2008-2018. We excluded case reports with less than 8 cases, and studies that did not report PAH specific treatment. We reviewed 3663 titles and extracted data from 10 publications. Pooled incidences and percentages of maternal and perinatal outcomes were calculated. |
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Result(s) There were 224 pregnancies in 213 women with PAH. In 8 studies (n=186 pregnancies) with early pregnancy outcomes, 25% had therapeutic abortions and 4% spontaneous miscarriages. 174 pregnancies continued beyond 20 weeks of gestation. In studies with functional class, 79% were class I or II pre-pregnancy and the mean PASP was 75±30 mmHg. The most common diagnosis was PAH associated with congenital heart disease (69%), followed by idiopathic (18%). With regards to PAH therapy; 21% were on a prostacyclin analogue, 23% on PDE-5 inhibitors, 8% on calcium channel blockers and combination therapy in 12%. The mean gestation age at delivery was 33 ± 5 weeks. Most women had Caesarean deliveries (77%); and 36% of pregnancies had general anesthesia. Overall maternal mortality rate beyond 20 weeks gestation was 11%; 6 maternal deaths occurred in 33 pregnancies with idiopathic PAH and 13 deaths in 124 pregnancies with congenital heart disease. There were no maternal deaths in PAH from other etiologies. Causes of death included pulmonary hypertension crisis, heart failure and shock. Premature births occurred in more than half of the pregnancies. Stillbirth occurred in 3% and neonatal mortality rate was 1%. |
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Conclusion In this systematic review of a contemporary cohort of pregnant women with PAH, maternal mortality continues to be a significant risk. Continued prospective studies are needed to improve outcomes and to better understand the role of PAH therapy. |