Pregnancy outcomes of 113 patients with pregnancy complicated with pulmonary hypertension

Background Pregnancy complicated with pulmonary hypertension(PH) is rare but carries great risk. Our aim is to explore the clinical characteristics and anesthesia management experience of pregnant women with PH, and to improve pregnancy outcomes. Methods A retrospective analysis was conducted on the clinical data of 113 pregnant women with PH admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to February 2025 Result Among 113 pregnant women with PH, 13 (11.50%) had idiopathic pulmonary arterial hypertension (IPAH), 32 (28.32%) had PAH complicated with congenital heart disease (CHD-PAH), and 44 (38.94%) had PAH complicated with left heart disease (LHD-PAH). There were 23 (20.35%) of PAH combined with other diseases (oPAH) and 1 (0.88%) of PAH caused by hereditary telangiectasia (HT-PAH). Pregnant women are classified into mild to moderate PH: pulmonary artery systolic pressure (sPAP) of 36-69mmHg (1mmHg = 0.133kPa) and severe PH: sPAP ≥ 70mmHg. 76 (67.26%)in the mild to moderate group and 37(32.74%) in the severe group. Two patients died, with a severe mortality rate of 5.4%. Compared with the mild to moderate PH group, the severe PH group had shorter gestational age, a higher proportion of New York Heart Association (NYHA) heart function grade 3–4 patients, a higher proportion of patients transferred to the intensive care unit (ICU), and longer hospital stays in the ICU. The incidence of perioperative cardiopulmonary complications is relatively high. 97 (85.84%) of patients chose cesarean section(CS), 43 (44.33%) chose general anesthesia, including 21 (56.76%) in the severe group. There were 10 cases (8.85%) of miscarriage and 7 (6.19%) of intrauterine fetal death. The preterm birth rate, low birth weight rate of newborns and neonatal asphyxia rate in the severe group were higher than those in the mild to moderate group. There was 1 (0.88%) of neonatal death in the severe group. Conclusion There are significant differences in pregnancy outcomes among pregnant women with varying degrees of PH. The pregnancy outcomes of patients with mild to moderate pulmonary hypertension are better. General anesthesia, when properly managed, can be safely used for cesarean section in patients with pregnancy complicated with severe pulmonary hypertension.