Anesthetic management of idiopathic pulmonary arterial hypertension for cesarean section – experiences from a tertiary care center

Introduction: Idiopathic pulmonary arterial hypertension (IPAH) is a rare cardiac disease. Recent studies have shown a decline in mortality due to the incorporation of PAH-specific therapy. Objective: The aim of our study was to examine the anesthetic management of patients with IPAH, who presented for cesarean section and to know the outcome of pregnancy. Materials and Methods: This is a retrospective observational review, where we have studied the maternal and fetal outcome and anesthetic management of IPAH who underwent elective cesarean section in a tertiary care center from 2010 to 2018. The demographic variables of the patient, details of pregnancy, maternal, and fetal outcome were analyzed. Results: All five patients studied had severe pulmonary arterial hypertension. Our maternal mortality rate was 20%. Except for one patient, all others received regional anesthesia. All patients went on inotropic support following induction, which was gradually tapered. Pulmonary artery catheter was not used in any of our patients. None of the patients required postoperative ventilation. Two babies were shifted to neonatal the intensive care unit in view of poor Apgar scores. Conclusion: Multidisciplinary approach involving cardiologist, obstetrician, and anesthetist is required in planning and management of these high-risk obstetric patients. Epidural anesthesia seems to be an alternative to general anesthesia for cesarean section. The risks versus benefit of pulmonary arterial catheter should be considered before its insertion. Despite all treatment efforts, maternal mortality is high. Hence, pregnancy should be discouraged, and preconceptional counseling and medical abortion should be offered if patient presents early or shows signs of deterioration.