Key result
Sildenafil monotherapy allowed stabilization of the maternal condition and resulted in the survival of both mothers and their babies in two pregnant women with severe pulmonary hypertension and Eisenmenger syndrome.
Why the study?
Does sildenafil monotherapy improve pregnancy outcomes in pregnant women with severe pulmonary hypertension and Eisenmenger syndrome?
Case Report (n=2)
No
Does sildenafil monotherapy improve pregnancy outcomes in pregnant women with severe pulmonary hypertension and Eisenmenger syndrome?
Sildenafil monotherapy may stabilize maternal condition and improve outcomes for both mother and baby in pregnancies complicated by severe pulmonary hypertension and Eisenmenger syndrome.
May support sildenafil in select severe PH/Eisenmenger pregnancies; leaves open need for prospective trials.
Pregnancy outcomes in patients with pulmonary arterial hypertension have not been documented in our local setting. In our institution, access to therapies like nitric oxide, inhaled prostacyclin and iloprost is limited. We describe two such women given sildenafil monotherapy between April and May 2011. Both had an atrial septal defect complicated by Eisenmenger syndrome. Both survived - one after elective Caesarean section for malpresentation (breech) under general anaesthesia, the other after an assisted vaginal delivery. In addition to oral sildenafil, both received oxygen supplementation. To date, there have been three reported cases of pulmonary arterial hypertension in pregnancy treated with sildenafil in combination with another drug. Our two cases demonstrate that treatment for pulmonary arterial hypertension using sildenafil as monotherapy may allow stabilization of the maternal condition and improve clinical outcomes for both mother and baby. However, pregnancy is still discouraged in women with pulmonary arterial hypertension.
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Cartago et al. (2014) conducted a case report in Severe pulmonary hypertension and Eisenmenger syndrome in pregnancy (n=2). Sildenafil was evaluated on Maternal and fetal survival. Sildenafil monotherapy allowed stabilization of the maternal condition and resulted in the survival of both mothers and their babies in two pregnant women with severe pulmonary hypertension and Eisenmenger syndrome.
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