Pulmonary hypertension in pregnancy is a risky position for both the mother and the fetus. Therefore, you must have an exhaustive and meticulous control of maternal and baby well-being.
Pulmonary hypertension in pregnancy is a challenge for obstetricians because due to the changes that occur during pregnancy, this underlying disease can be aggravated. It even leads to the death of both the mother and the fetus.
The prognosis is always reserved, but fortunately, it is an infrequent pathology in the general population. However, despite medical advances in its approach, there is still maternal mortality of 30 to 50%.
What is pulmonary hypertension?
In pulmonary hypertension, there is an obstruction or occlusion of the branches of the pulmonary artery. This blood vessel carries blood from the right ventricle to the alveoli, allowing carbon dioxide to escape to the outside and oxygenating to return to the left side of the heart.
Due to the obstruction, whatever the cause, the blood cannot continue its path and remains stagnant in the right ventricle, which must exert greater force for expulsion. Over the years, with this unsustainable situation, the heart on the right side fails, and heart failure ensues.
The fact that the blood cannot pass through the lungs and that it does not reach the left ventricle means that the person does not have well-oxygenated organs, causing shortness of breath, tiredness, fatigue and even fainting. If adequate treatment is not instituted, pulmonary hypertension causes death.You can check out more healthideas on Scrigg as well.
During pregnancy, the woman’s body has to adapt to the demands and demands of the fetus. That is why, from the first trimester, there are a series of changes that are physiological and that reach their maximum at the end of the second trimester. We tell you some of them that are important to understand the effects of pulmonary hypertension in pregnancy.
- Increased plasma volume of blood: The main components of blood are red blood cells and plasma, which is a liquid made up of water, proteins, fats, sugars, vitamins and hormones. In pregnancy, there is an increase in this plasma; however, the red blood cells remain the same.
- Increased cardiac output: Since the sole support of the fetus is the mother. Her heart has to pump more blood to reach the placenta. Therefore, the maternalcardiacoutput (volume of blood expulsion to the rest of the body per minute) increases.
- Decreased peripheral resistance: the blood vessels in the mother’s body are more relaxed and generate less resistance to the passage of blood. This lower peripheral resistance causes blood pressure or pressure to decrease and be lower.
- Hypercoagulability: pregnant women are more likely to have more viscous blood, thus increasing their risk of thrombi and clots.
What influence does pregnancy have on pulmonary hypertension?
A pregnant woman must have a Healthy heart to increase her cardiac output and decrease peripheral resistance. In this way, you can provide all the necessary nutrients to the fetus.
In the case of pregnant women with pulmonary hypertension, it is more complicated. These patients are not able to increase cardiac output enough or to relax blood vessels to decrease resistance.
These difficulties lead to the fetus receiving less blood and an increased risk of pre-eclampsia and premature delivery. On the other hand, with the mother’s low cardiac output, the pregnant woman is left with less flow for her own body.
This continues after the delivery is over. During and after it, the woman increases her resistance in the blood vessels, as a natural process. When pulmonary hypertension is present, the smaller diameter of the vessels becomes more acute, and the risk of death increases exponentially.
What do the experts suggest?
Pregnancy is a risk factor for worsening pulmonary hypertension, and therefore experts contraindicate pregnancies in these women. If despite having explained all the risks, the woman wants to become pregnant, a series of precautions must be taken.
On the other hand, there is also the case of patients who do not know that they have pulmonary hypertension until they become pregnant since they did not have any symptoms before. In them, proper monitoring and treatment are also important.
The management of pulmonary hypertension in pregnancy requires a multidisciplinary medical team. Patients should follow a monthly control if they are asymptomatic or closer monitoring if they show symptoms. Also, with the minimum complication or worsening, the pregnant woman should be admitted to hospitalization.
The drugs that can be used are pulmonary vasodilators, which must be applied early in pregnancy. If they were taken before, the dose should be adjusted to the new situation.
Childbirth and, especially, the puerperium, are the two situations that most exacerbate pulmonary hypertension. There is no scientific consensus on whether it is better to perform a cesarean section or vaginal delivery. Therefore, the choice must be individualized and agreed.
Finally, since the puerperium is when there are more maternal deaths, it must be closely monitored. For this reason, the mother remains at least 72 hours in intensive care until she is discharged.