BACKGROUND: The aim of this study was to present our institutional experience with periprocedural management of emergency cesarean section (CS) operations and maternal and fetal cardiac complications in pregnant women with pulmonary hypertension (PH).

METHODS: Thirteen patients who were diagnosed with PH during pregnancy and/or prior to pregnancy according to European Society of Cardiology (ESC) criteria, and who were referred to our hospital with a decision for emergency CS from an external center, were included in the study. For patients who underwent urgent surgery, the following data were recorded: demographic characteristics, time of diagnosis, treatments for pulmonary hypertension used before pregnancy, during pregnancy, and/or after CS, arterial blood gas values, pulmonary and systemic pressure values after induction and at the 12th postoperative hour, extracorporeal membrane oxygenation (ECMO) requirements, time to extubation, length of intensive care stay, and mortality rates.

RESULTS: Eight of the 13 patients were diagnosed with idiopathic pulmonary arterial hypertension (IPAH). The mean systolic systemic arterial pressure (BPs), systolic pulmonary arterial pressure (PAPs), and mean pulmonary arterial pressure were 130±14.2 mmHg, 93±28 mmHg, and 52±17 mmHg, respectively. Six of the 13 patients required ECMO support. The one-month mortality rate was 46%.

CONCLUSION: Pregnancy in women with PH is associated with significant maternal morbidity and mortality. If the underlying etiology is IPAH, the risk of mortality is higher than in other forms of PH. Mechanical circulatory support devices, including ECMO, may serve as a temporary bridge to lung transplantation in selected cases. Therefore, early diagnosis of IPAH, timely referral of patients to specialized centers, and planning of these operations by a multidisciplinary team consisting of cardiologists, gynecologists, and cardiac anesthesiologists are necessary.