Pulmonary Hypertension News has reported that a pregnant patient with pulmonary arterial hypertension (PAH) has had a successful pregnancy and delivery thanks to aggressive treatment by her medical team. PAH is a condition that involves high blood pressure in the lungs. It is chronic and can lead to right heart failure. Women with PAH are discouraged from becoming pregnant, due to the increased demand on the cardiopulmonary system. If they do become pregnant, women with PAH are almost always advised to abort their children due to a maternal mortality rate found in past studies to be between 30 and 56 percent. (This maternal mortality rate is based on studies conducted prior to women undergoing the same treatment that this mother agreed to.)
At 18 weeks pregnant, the 30-year-old woman went to the hospital with breathing difficulties. Having already endured four miscarriages and two elective abortions due to concerns about her health, she refused abortion for this child when doctors recommended it. She agreed, instead, to an aggressive medication treatment plan as well as careful and constant observation and a long-term stay in the hospital during her last trimester.
A study was done during her pregnancy as she was monitored carefully, receiving iloprost and heparin infusions for three to four days at 20-day intervals. During her last month of pregnancy, she stayed in the hospital receiving iloprost infusions. (Her medical treatment is detailed here.) The riskiest time for a pregnant woman with PAH, however, is the first ten days after delivery, according to Pulmonary Hypertension News. Therefore, during this time, doctors continued to carefully monitor the mother’s health after she delivered her baby at 36 weeks gestation via C-section.
She continued on an aggressive medication plan after delivery, but had to return to the hospital within days with breathing difficulties. Her lower right heart chamber was found to be severely enlarged, but doctors were able to stablize her with medication, and she was able to return home.
“Severe PAH is regarded as a contraindication to pregnancy,” researchers reported. “While physicians strongly recommend termination of the pregnancy in such patients, some of them might refuse and insist on delivery of the baby. Similar pregnant cases with potential delivery are recommended to be evaluated for effective management of this condition.”
According to the study, prior to 1985, people diagnosed with PAH lived for an average of just 2.8 years after diagnosis. Advancing treatments for PAH are leading to better knowledge and understanding about the condition, improving quality and length of life, and allowing more women with the condition to have successful pregnancies with treatment centered on saving their lives and the lives of their children.
This brave woman just may be paving the way for many women after her.