Authors
Kyung-Jin Ahn, Wook-Jin Chung, Albert Youngwoo Jang, Chang Hu Choi, Kyung Cheon Lee, Suk Young Kim
Published in
JACC. Case reports. Pages 109896. Aug 21, 2026. Epub Aug 21, 2026.
Abstract
Pregnancy in patients with pulmonary arterial hypertension (PAH) carries substantial maternal and fetal risk, necessitating meticulous hemodynamic control and multidisciplinary management.
A pregnant woman with severe PAH secondary to an uncorrected atrial septal defect was diagnosed in the third trimester. A multidisciplinary team initiated parenteral prostacyclin therapy and phosphodiesterase-5 inhibition to reduce pulmonary vascular resistance. Delivery was planned under regional anesthesia with extracorporeal membrane oxygenation on standby. Oxytocin was deliberately avoided to minimize systemic vasodilation and the risk of pulmonary hypertensive crisis. Cesarean delivery was successfully performed, resulting in favorable maternal and neonatal outcomes. Postpartum management included escalation of PAH-targeted therapy and intensive monitoring.
Carefully coordinated multidisciplinary management and avoidance of oxytocin may help mitigate peripartum hemodynamic instability in pregnancies complicated by severe PAH.
Avoidance of exogenous oxytocin, proactive multidisciplinary planning, and preparedness for mechanical circulatory support are critical in managing high-risk pregnancies complicated by severe PAH. Endogenous oxytocin surges during lactation may induce hemodynamic instability in patients with PAH, highlighting the critical need for intensive postpartum monitoring and lactation suppression.
PMID:
42627315
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.
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