Research gives us reason to believe that a planned early delivery at 32–34 weeks, before any clinical
deterioration, is an important contributor to good outcome [11,12,42]. Later delivery (34–37 weeks)
may be possible in completely stable women who have mild pulmonary hypertension without further
elevation of pulmonary pressures during pregnancy. Vaginal delivery is not contraindicated; however,
early delivery often necessitates a caesarean section in many cases. In the review of Bedard et al. [3]
general anaesthesia was associated with worse outcome than epidural or spinal anesthesia. This
may be because women receiving general anaesthesia had more severe disease, but negative effects of
general anaesthesia include an increase in pulmonary pressures and cardiodepression [3]. Probably
expert application of epidural or a combination of epidural and spinal anaesthesia is the best option for
these women. During delivery, monitoring of haemodynamics (e.g. heart rate, blood pressure, oxygen
saturation) is required, but the benefit of invasive monitoring of pulmonary artery pressures is
debatable.
Research gives us reason to believe that a planned early delivery at 32–34 weeks, before any clinicaldeterioration, is an important contributor to good outcome [11,12,42]. Later delivery (34–37 weeks)may be possible in completely stable women who have mild pulmonary hypertension without furtherelevation of pulmonary pressures during pregnancy. Vaginal delivery is not contraindicated; however,early delivery often necessitates a caesarean section in many cases. In the review of Bedard et al. [3]general anaesthesia was associated with worse outcome than epidural or spinal anesthesia. Thismay be because women receiving general anaesthesia had more severe disease, but negative effects ofgeneral anaesthesia include an increase in pulmonary pressures and cardiodepression [3]. Probablyexpert application of epidural or a combination of epidural and spinal anaesthesia is the best option forthese women. During delivery, monitoring of haemodynamics (e.g. heart rate, blood pressure, oxygensaturation) is required, but the benefit of invasive monitoring of pulmonary artery pressures isdebatable.
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