Discussion
PPH is defined as a sustained elevation of PASP
(mean greater than 25 mmHg at rest) in the absence
of a demonstrable cause. Pulmonary vasoconstriction,
medial hypertrophy, thrombosis
in situ and dysfunctional pulmonary vascular
endothelium are believed to be the underlying
contributing mechanisms [4].
Pulmonary hypertension is poorly tolerated
during pregnancy. Deterioration typically occurs
in the second trimester with symptoms of fatigue,
dyspnoea, syncope and chest pain. This corresponds
to the physiological increase in cardiac
output and blood volume of 40%. During labour,
uterine contractions effectively add 500 ml of
blood to the circulation. The labour pain increase
right atrial pressure, blood pressure and cardiac
output [5]. Women with PPH is advised against
pregnancy. In early pregnancy a termination is
considered. Where PPH is not diagnosed until late
pregnancy an elective delivery with caesarean section
is preferred. This facilitates cooperation between
specialities, permits monitoring to be
started in advance, the pain and haemodynamic
consequences of labour to be minimized and an
intensive care bed to be arranged. Premature
spontaneous labour is common [2] therefore delivery
is usually planned for 32–34 weeks gestation.
In our patient the cardiovascular physiological
Figure 3. Severe Tricuspid regurgitation with peak TR velocity of (5.5 m/s) with high right ventricular systolic pressure (RVSP) of 125 mm Hg.
CASE REPORT
J Saudi Heart Assoc
2013;25:219–223
ALBACKR ET AL 221
PRIMARY PULMONARY HYPERTENSION DURING PREGNANCY