As discussed, pregnancy is contraindicated with severe disease, especially in women with pulmonary arterial changesmost cases in group 1. With milder disease from other causes-group 2 being the most common-the prognosis is better (Meng, 2017). With the more frequent use of echocardiography and pulmonary artery catheterization in young women with heart disease, we have identified women with mild-to-moderate pulmonary hypertension who tolerate pregnancy, labor, and delivery well. One example described by Sheield and Cunningham (2004) is that of pulmonary hypertension that develops with thyrotoxicosis but is reversible with treatment. Similarly, Boggess and colleagues (1995) described nine women with interstitial and restrictive lung disease with varying degrees of pulmonary hypertension, and all tolerated pregnancy reasonably well.
Treatment of symptomatic pregnant women includes activity limitation and avoidance of the supine position later in gestation. Diuretics, supplemental oxygen, and pulmonary vasodilator drugs are standard therapy for symptoms. Some recommend anticoagulation (Hsu, 2011). Several reports describe the successful use of intravenous pulmonary artery vasodilators (Badalian, 2000; Garabedian, 2010; Goya, 2014). Prostacyclin analogues that can be administered parenterally include epoprostenol and treprostinil, whereas iloprost is inhaled. Each has been used in gravidas. Inhaled nitric oxide is an option that has been employed in cases of acute cardiopulmonary decompensation (Lane, 2011). As reviewed by Obiean and Cleary (2014), phosphodiesterase-5 inhibitors, such as sildenail, cause vasodilation of both the pulmonary and systemic vascular beds and have an inotropic efect on the hypertrophic right ventricle. his also has been used to advantage during pregnancy (Goland, 2010; Hsu, 2011; Meng, 2017). Bosentan, an endothelin-receptor antagonist, is teratogenic in mice and contraindicated in pregnancy (Obican, 2014).
During labor and delivery, these women are at greatest risk when venous return and right ventricular filling are diminished. To avoid hypotension, assiduous attention is given to epidural analgesia induction and to blood loss prevention and treatment at delivery (Meng, 2017).
The American Heart Association defines these as a heterogeneous group of myocardial diseases associated with mechanical and/ or electrical dysfunction. Afected women usually-but not invariably-have inappropriate ventricular hypertrophy or dilation. Cardiomyopathies stem from varied causes, some of which are genetic (Maron, 2006). Of the two major divisions, primay cardiomyopathies are solely or predominantly conined to heart muscle. Examples are hypertrophic cardiomyopathy, dilated cardiomyopathies, and peripartum cardiomyopathy. Secondary cardiomyopathies result from generalized systemic disorders that produce pathological myocardial involvement. Diabetes, systemic lupus erythematosus, chronic hypertension, and thyroid disorders are representative conditions.