Peripartum Anaesthetic Management of Newly Diagnosed Pulmonary Hypertension: A Case Series

Newly diagnosed Pulmonary Hypertension (PH) in pregnancy can result in significant health concerns and complications in anaesthesia management for caesarean section delivery. Here, the authors, describe the cases of three pregnant patients who were scheduled for emergency caesarean sections with a new diagnosis of PH. These patients presented with nonspecific symptoms of dyspnoea on exertion and lower extremity swelling, which initially were believed to be due to changes occurring during normal pregnancy. Further evaluation, including echocardiography, revealed different degrees of PH with preserved Left Ventricular Ejection Fraction (LVEF). All patients underwent combined spinal and epidural anaesthesia for their surgical procedure. A low-dose spinal anaesthetic was administered with epidural boluses to achieve analgesia. The sympathetic blockade was managed judiciously to maintain stable blood pressure. Norepinephrine was administered to all patients in order to support right ventricular function, and supplemental oxygen was administered as needed. Blood pressure was closely monitored throughout. In the postoperative period, all three patients were transferred to the intensive care unit for close monitoring. The postoperative course for all patients was uneventful, and they were discharged without complications. This experience emphasises the importance of early recognition of unusual symptoms in pregnancy, early echocardiography, neuraxial anaesthesia, and vigilant monitoring and collaboration in order to achieve a successful outcome for women newly diagnosed with PH.