Pregnancy Outcome in Women with Pulmonary Artery Hypertension: A Retrospective Time-bound Study in a Tertiary Care Institute in North Eastern India

Background: Pregnancy complicated with pulmonary artery hypertension (PAH), lies at increased risk of maternal and neonatal complications.Although studies have reported mortality rates of up to 56% associated with pregnancy in PAH, however, with a multidisciplinary approach including obstetrics, anesthesia, and cardiology, care in women with PAH has improved.It is necessary to investigate if such a modern multidisciplinary approach has led to a reduction in maternal mortality and has improved maternal and fetal outcomes.Aim: Our study evaluates maternal and fetal outcomes in pregnant women with PAH in a tertiary care setting in North Eastern India with a multidisciplinary approach.Materials and methods: This retrospective, hospital-based, time-bound study was done on 54 pregnancies complicated by PAH, over one and a half years.Patients were evaluated for the development of any cardiac complications like arrhythmia, congestive cardiac failure, thromboembolism, and atrial fibrillation.Maternal obstetric complications were evaluated like postpartum hemorrhage, anemia, and pregnancyinduced hypertension.Gestational age at delivery and mode of delivery were also noted.Fetal complications like preterm delivery, fetal growth restriction, intrauterine fetal death, and congenital cardiac disease were noted.Results: The mode of delivery was LSCS in the majority (77.7%), with the mean gestational age of delivery being 38 weeks and 5 days.On the assessment of PAH, the mild degree was seen in the majority of cases (55.6%), moderate PAH in around 29.6%, and a severe degree of PAH was seen in only 14.8% of cases.The majority of cardiac defects associated with PAH were congenital cardiac diseases in the form of ASD and VSD (68.5%).The majority of patients had spinal anesthesia (42.85%) during LSCS.General anesthesia was used in only 10 cases (23.8%).Preterm deliveries and fetal growth restriction were seen in around 14 and 33% of cases respectively, with no intrauterine fetal death.Cardiac complications occurred in 11% of cases and maternal obstetric complications occurred in 29.6% of cases.No maternal death was noted in the study group.On further analysis, it was seen that maternal complications were significantly higher among those with a higher degree of PAH (p = 0.006).Also, the baby's birth weight was significantly lower with an increase in the severity of PAH.On Bonferroni post hoc analysis, the association was between mild and severe PAH (p < 0.01) and between moderate and severe PAH (p = 0.016). Conclusion:Our study has shown no maternal mortality over a group of 54 pregnant women.This study thereby appraises the contribution of a multidisciplinary approach in the management of these patients.