Pulmonary Hypertension in Pregnancy

Pregnancy complicated with pulmonary hypertension is a severe and dangerous condition. Due to changes in the maternal cardiovascular system, the symptoms of pulmonary hypertension during pregnancy may be more severe compared with those in non-pregnant women. This review describes effective treatment methods, including preconception counseling and monitoring, overall care, labor and postpartum care, contraception, maternal and fetal outcomes, and principles of diagnostics and management. The review was performed in line with the PRISMA guidelines across eLibrary and PubMed databases in 2024. The search queries were легочная артериальная гипертензия у беременных (pulmonary hypertension in pregnancy), осложнения беременности и родов при легочной артериальной гипертензии (complications of pregnancy and labor in pulmonary hypertension), прегравидарная подготовка у пациенток с легочной артериальной гипертензией (preconception care in patients with pulmonary hypertension), контрацепция у пациенток с легочной артериальной гипертензией (contraception in patients with pulmonary hypertension), анестезия при родоразрешении беременных с легочной артериальной гипертензией (anesthesia in labor in pregnant women with pulmonary arterial hypertension). The review included the studies of any design published in these databases over the past decade. The initial search identified 235 articles, yielding 89 titles after removal of duplicates, abstracts, and summaries without an available full-text version. After removal of 56 articles that did not meet the inclusion criteria, 33 full-text articles were analyzed and included in the review. It was found that pulmonary hypertension in pregnancy is a rare condition associated with a high complication rate and mortality. The study data obtained in recent years demonstrate better survival rates in the patients with such condition. The management and delivery of pregnant women with comorbid pulmonary hypertension are difficult. For successful outcomes, they require a personalized and multidisciplinary approach. All women with pulmonary hypertension should avoid pregnancy due to the high risk of maternal mortality. Close maternal and fetal observation by a multidisciplinary team during pregnancy and labor is recommended in case of pregnancy maintenance. There is no current consensus on drug and dose selection for women with pulmonary hypertension. The choice of the abortion time, labor time, and anesthesia is based on individual needs and risk assessment. The possible association between pulmonary hypertension and pre-eclampsia deserves special attention and further study.