Analysis of the clinical characteristics and pregnancy outcomes of pregnant women with severe pulmonary hypertension

Lu Yuqiu; Zhang Jun; Zhang Dawei

doi:10.3760/j.issn.1673-4777.2025.06.014

Abstract：Objective To investigate the clinical characteristics and pregnancy outcomes of pregnant women with severe pulmonary hypertension(PH).Methods The clinical data of 40 pregnant women with severe PH admitted to Beijing Anzhen Hospital,Capital Medical University from January 2018 to December 2023 were retrospectively analyzed.Considering that there was a certain correlation between related indicators and cardiac function,40 patients were summarized according to the classification of cardiac function,including 20 cases of grade Ⅱ,13 cases of grade Ⅲ,and 7 cases of grade Ⅳ.Maternal age,gravidity and parity time,the proportion of patients with increased brain natriuretic peptide(BNP)and decreased platelet count(PLT)during pregnancy and before discharge,the proportion of full-term pregnancy,gestational age at delivery and maternal and fetal outcomes were collected and analyzed.Results Among the 40 patients,36 were primiparas and 4 were multiparas.The 36 patients used diuretics and potassium supplement drugs during pregnancy and perinatal period.BNP increased in 18 cases(45.0％)of 40 patients in the second trimester,including 6 cases with cardiac function grade Ⅱ,Ⅲ and Ⅳ,respectively.Six patients recovered to normal before discharge,and the higher the propor-tion of BNP elevation in patients with poorer cardiac function,the lower the proportion of patients who recovered to normal before discharge.The worse the cardiac function,the higher the proportion of PLT decline.Among the 40 patients,6 cases(15.0％)were full-term pregnant(gestational age ≥37 weeks),and there were 5,1,and 0 patients with cardiac function class Ⅱ,Ⅲ,and Ⅳ,respectively.The proportion of full-term pregnancy was low in patients with higher cardiac function class.Two cases(5.0％)were extremely premature,accounting for 1,0,and 1 respectively among patients with cardiac function grades Ⅱ,Ⅲ,and Ⅳ.Patients with heart function gradeⅣ had a higher proportion of extremely premature births.The gestational weeks of delivery for patients with cardiac function grades Ⅱ,Ⅲ,and Ⅳ were(33.0±3.1),(32.5±3.2),and(32.9±3.0)weeks,respectively.Through multidisciplinary collaborative diagnosis and treatment management,there was 1 maternal death among patients with different functional classifications.One newborn died,and the pregnant woman had a cardiac function grade Ⅲ patient;there were 4 cases of neonatal asphyxia,with 2,1,and 1 cases of cardiac function grade Ⅱ,Ⅲ,and Ⅳ patients,respectively.Conclusion Pregnancy with severe PH has serious adverse effects on mother and fetus.Better pregnancy outcomes can be achieved through multidisciplinary collaborative diagnosis and management.