RT Book, Section A1 Duarte, Alexander G. A2 Pacheco, Luis D. A2 Saade, George R. A2 Hankins, Gary D.V. SR Print(0) ID 1115519497 T1 Pulmonary Hypertension T2 Maternal Medicine YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071824163 LK obgyn.mhmedical.com/content.aspx?aid=1115519497 RD 2024/03/28 AB Cardiac disease is a frequent cause of morbidity and mortality during pregnancy.1,2 In the past, mitral stenosis because of rheumatic heart disease was the most common cause of cardiac disease associated with pregnancy; however, two registries indicate that congenital heart disease is the most prevalent form of heart disease complicating pregnancy.3,4 Notably, mitral stenosis and congenital heart disease are associated with the development of pulmonary vascular disease. However, congenital heart disease associated with pulmonary hypertension and idiopathic pulmonary arterial hypertension (PAH) are significant causes of morbidity and mortality in the parturient with case series indicating a 30% to 56% maternal and 9.5% fetal mortality.2,5 PAH affects young women, and advances in therapies have allowed women with PAH to survive to childbearing years thereby resulting in a greater number of parturients with this disease process.6 Yet, consensus guidelines recommend that women with pulmonary hypertension, who are of child bearing potential, use effective contraception to avoid pregnancy and in the event of pregnancy, early termination is advised.7 Although these recommendations are medically justifiable, some patients become pregnant against medical advice or consider pregnancy termination as morally objectionable.8,9,10 Hence, prenatal counseling concerning contraception and management during and after pregnancy are important issues in this group. This chapter will focus on management of PAH during and after pregnancy in the current era of PAH-specific therapies.