Comparative analysis of anesthetic approaches in pregnant women with pulmonary arterial hypertension: a retrospective cohort study

Purpose: This retrospective cohort study aimed to evaluate the impact of different anesthesia techniques on peripartum outcomes in parturients with pulmonary arterial hypertension (PAH). Methods: We analyzed clinical data from 175 PAH patients who admitted to the West China Second Hospital of Sichuan University. Outcomes were compared between neuraxial anesthesia and general anesthesia. The primary outcome was a composite of maternal or fetal outcomes, including the proportion of Apgar <7, fetal or maternal in-hospital mortality, the incidence of postoperative cardiac troponin T (cTnT) elevation, brain natriuretic peptide (BNP) or pulmonary arterial pressure (PAP) increase, or postoperative persistence of right heart enlargement. Secondary outcomes included the incidence of maternal or neonatal intensive care unit (ICU) admission rates, maternal ICU length of stay, and postoperative maternal hospital stay duration. Results: In the study population (median age: 29 yrs, median PAP: 56mmHg [range: 43.0 to 78.5mmHg]), 86.9% of the patients who underwent caesarean section, and 22.3% of the PAH-specific medication. Neuraxial anesthesia improved maternal and neonatal outcomes compared to general anesthesia (adjusted Odds ratio [OR] 0.28; 95% confidence interval [CI] 0.10 to 0.73; P =0.011). Subgroup analyses revealed that these associations remained consistent across age groups, New York Heart Association (NYHA), PAP severity levels, and PAH-specific medication use. All neuraxial anesthetic techniques—combined spinal-epidural, single epidural, and dual-epidural anesthesia—demonstrated better composite outcomes (ORs ranging from 0.24 to 0.31) compared to general anesthesia. Secondary outcomes were similar between the two anesthetic groups. Conclusion: General anesthesia was associated with an increased risk of adverse perinatal outcomes in parturients with PAH. However, further studies are warranted to definitively establish the optimal anesthetic technique for pregnant women with PAH.