A 38-year-old female who was found to have severe pulmonary arterial hypertension (PAH) secondary to HIV in the postpartum period. This case illustrates the treatment and challenges of postpartum PAH. It also demonstrates the need for expert guidance and additional research on the optimal management of PAH in pregnancy and postpartum.
PoppasAShroffSKorcarzC, et al.Serial assessment of the cardiovascular system in normal pregnancy. Role of arterial compliance and pulsatile arterial load. Circulation1997; 95: 2407–2415.
2.
YentisSMSteerPJPlaatF. Eisenmenger’s syndrome in pregnancy: Maternal and fetal mortality in the 1990s. Br J Obstet Gynaecol1998; 105: 921–922.
3.
StoutKKDanielsCJAboulhosnJA, et al.2018 AHA/ACC Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation2019; 139: e698–e800.
4.
KielyDGCondliffeRWilsonVJ, et al.Pregnancy and pulmonary hypertension: a practical approach to management. Obstet Med2013; 6: 144–154.
5.
BenzaRLGomberg-MaitlandMGreg ElliottC, et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies. Chest2019; 156: 323–337.
6.
BanerjeeDVentetuoloCE. Pulmonary hypertension in pregnancy. Semin Respir Crit Care Med2017; 38: 148–159.
7.
VaughtAJKovelLCSzymanskiLM, et al.Acute cardiac effects of severe pre-eclampsia. J Am Coll Cardiol2018; 72: 1–11.
8.
McNeilAChenJMengML. Pulmonary hypertension in pregnancy—the Anesthesiologist’s perspective. Int J Cardiol Congenit Heart Dis2021; 5: 100234.
9.
HemnesARKielyDGCockrillBA, et al.Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute. Pulm Circ2015; 5: 435–465.
LittleKMKilmarxPHTaylorAW, et al.A review of evidence for transmission of HIV from children to breastfeeding women and implications for prevention. Pediatr Infect Dis J2012; 31: 938–942.
12.
Drugs and lactation Database (LactMed). National Library of Medicine. Available at: https://www.ncbi. nlm.nih.gov/books/NBK501922/.
13.
BédardEDimopoulosKGatzoulisMA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension?Eur Heart J2009; 30: 256–265.
