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The use of iloprost in early pregnancy in patients with pulmonary arterial hypertension

¹ Sheffield Pulmonary Vascular Disease Unit, ² Dept of Obstetrics and Gynaecology, ³ Dept of Anaesthesia and Critical Care, and ⁴ Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Sheffield, and ⁵ Dept of Obstetrics and Gynaecology, and ⁶ Leicester Royal Infirmary, Congenital Heart Service, Glenfield Hospital, Leicester, UK.

CORRESPONDENCE: D. G. Kiely, Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF, UK. Fax: 44 1142711718. E-mail: david.kiely@sth.nhs.uk

Keywords: Caesarean section, iloprost, local anaesthesia, pregnancy, pulmonary hypertension

Received: November 9, 2004
Accepted March 28, 2005

In patients with pulmonary hypertension, pregnancy is associated with a high risk of maternal death. Such patients are counselled to avoid pregnancy, or if it occurs, are offered early interruption. Some patients, however, decide to continue with their pregnancy and others may present with symptoms for the first time whilst pregnant. Pulmonary vasodilator therapy provides a treatment option for these high-risk patients.

The present study describes three patients with pulmonary arterial hypertension of various aetiologies who were treated with the prostacyclin analogue iloprost during pregnancy, and the post-partum period.

Nebulised iloprost commenced as early as 8 weeks of gestation and patients were admitted to hospital between 24–36 weeks of gestation. All pregnancies were completed with a duration of between 25–36 weeks and all deliveries were by caesarean section under local anaesthetic. All patients delivered children free from congenital abnormalities, and there was no post-partum maternal or infant mortality.

In conclusion, although pregnancy is strongly advised against in those with pulmonary hypertension, the current authors have achieved a successful outcome for mother and foetus with a multidisciplinary approach and targeted pulmonary vascular therapy.

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