Pulmonary hypertension and pregnancy: the experience of a tertiary institution over 15 years.

BACKGROUND: Pulmonary hypertension (PH) in pregnancy is associated with a high maternal mortality and morbidity and has been found to be as high as 30-56%. AIM: To review the management of such patients in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small case series and 2 meta-analyses. MATERIALS AND METHODS: A review of all patients admitted to our institution for management of PH in pregnancy between 1994 and February 2009 was undertaken. Cases were identified from the high-risk pregnancy database within the department of anesthesia and from the hospital medical records. Severity of PH, type of PH, NYHA functional status at presentation and delivery, mode of delivery, peripartum monitoring and APGAR scores were noted. Patients were reviewed by a multidisciplinary team and management planned accordingly. RESULTS: 19 eligible patients were identified. Patients who were significantly sick due to their PH were aggressively managed during pregnancy. Overall there was an improvement in NYHA functional status at the time of delivery. Epidural analgesia and anesthesia for labor and operatively delivery seem to be the ideal choice. CONCLUSION: Multidisciplinary approach is a key to the successful management of these patients. Secondary PH results in higher morbidity and mortality, in particular, older the age higher the maternal morbidity and mortality.

Validity of anaesthetic complication coding data as a clinical indicator.

Clinical indicators using routinely collected International Statistical Classification of Diseases, Australian Modification (ICD-10-AM) data offer promise as tools for improvement of quality. The ICD-10-AM is the coding system used by Australian administrators to summarise information from the clinical record to describe a patient's hospital encounter. The use of anaesthesia complications as coded by this system has been proposed by two jurisdictions as a monitor of the quality of anaesthetic services. We undertook a review of cases identified by such indicators in a large tertiary hospital. Our results indicate the anaesthesia indicator dataset proposed by the Victorian and Queensland Health departments appears to have little clinical or quality improvement relevance.