Pregnancy Outcome And Its Risk Factors Of Pregnancy Complicated With Pulmonary Hypertension

Background & purposePulmonary arterial hypertension is a critical condition of pregnancy and endangers the lives of mothers and fetuses,which lead high mortality.Multidisciplinary treatment is often required.The purpose of this study is to investigate the classification of pulmonary hypertension in pregnancy,analysis its complication,pregnancy outcomes and its risk factors,which can provide a reference for clinical management,and also improve the quality of treatment and clinical outcomes.Methodwe retrospectively analysis of the clinical data of 145 pregnant patients with pulmonary hypertension diagnosed and treated in the Third Affiliated Hospital of Guangzhou Medical University from September 2009 to September 2017.The purpose is to understand the composition of pulmonary hypertension,compare the pregnancy outcome and neonatal outcome of three degrees of pulmonary hypertension(mild,moderate,severe).we also use univariate and multivariate logistic regression analysis,to assess risk factors for pregnancy outcomes.Result(1)The proportion of pulmonary arterial hypertension was the highest(60%),among which the congenital heart disease was highest in patients with pregnancy complicated with heart disease,followed by primary pulmonary hypertension(16.67%).Left heart disease is taken up 40%,Chronic thromboembolic pulmonary hypertension,chronic pulmonary disease,and pulmonary hypertension caused by hypoxia,nor pulmonary hypertension caused by a definite multifactorial mechanism was not founded.(2)The average gestational age of three degrees pulmonary hypertention(mild,moderate,severe)was respectively 36.3±3.4 weeks,35.9±2.6 weeks,and 32.5±3.9 weeks.The cesarean section rates of the three groups were all over 70%,and severe group is even more than 77%.The most of the mild pulmonary hypertension can be delivered at term,and most of the severe groups deliver at 34 weeks and earlier.(3)There were 93 in the mild PH group,34 in the moderate PH group,and 18 in the severe PH group.The abortion rates of the mild,moderate and severe groups were 13.9%,14.7%,and 16.7% respectively.A total of 30 patients developed heart failure,including 12 mild cases,11 moderate cases,and 7 severe cases.Congenital heart diseases,especially with Eisenmenger syndrome,is the most common cause in death cases.There are no cases of cardiomyopathy,rheumatic cardiomyopathy,and valvular heart disease resulting to die.A total of 124 live infants were relatively consistent with the preterm birth rate.The lighter the infant's birth weight was followed the higher the PH level,and the neonatal mortality rate was 3.2%,mainly due to premature infants with signs of respiratory distress.According to multivariate logistic regression analysis,oxygen saturation<=90%,irregular blood test,NYHA classification III-IV,BNP precursor>=300 pg/ml,PAP>=50 mmHg are the risk factors of heart failures or death.ConclusionPatients with pulmonary hypertension have higher adverse pregnancy outcomes.The higher the pulmonary artery pressure lead to the higher maternal complication events,including mortality,miscarriage rate and birth rate of low birth weight infants.Cesarean section is still the main mode of delivery.Patients with moderate or severe PH are not recommended for pregnancy because of the high complications.Pregnant mothers and fetuses should be assessed every one to two weeks during pregnancy.Echocardiographic assessment of pulmonary hypertension is easier and more acceptable than right heart catheterization for patients,and show earlier the changeof heart function than NYHA classification.