Primary pulmonary hypertension in pregnancy: Vaginal delivery with epidural labour analgesia.

ABSTRACT

Primary pulmonary hypertension is a very rare, progressive, incurable disease, the only curable option being heart lung transplant. When pregnancy is associated with pulmonary hypertension due to any cause, it carries very poor prognosis with mortality rate ranging from 30-50%. More risk is involved during labour & peripartum period, as labour pain with hypercarbia, hypoxia, acidosis, increases sympathomimetic responses and pulmonary vascular resistance which could be fatal to parturient. Epidural labour analgesia with painless vaginal delivery attenuates these responses & improves survival rate. It also helps in accommodating the auto transfused blood in postpartum period due to controlled vasodilatation & so avoiding right ventricular failure. Case report We report a case of a primigravida patient with primary pulmonary hypertension who was advised therapeutic abortion, but she continued with pregnancy and underwent vaginal delivery with epidural analgesia & was continuously haemodynamically monitored non-invasively during labour & postpartum period.