Pulmonary Hypertension Can Present Pregnancy Challenges For Mom & Baby

PITTSBURGH (KDKA) – Joy Lauver has a life-threatening lung condition called pulmonary hypertension, a side effect of the chemotherapy she received for an earlier bout of leukemia.

She didn’t think much of it, aside from some mild breathing issues when climbing hills or stairs.

“I wasn’t really familiar with what the pulmonary hypertension was and how serious it could get,” Joy said.

Then, she found herself 30 weeks pregnant and in a lot of trouble.

“The combination of pregnancy and pulmonary hypertension is deadly,” says Dr. Raymond Benza, a cardiologist at Allegheny General Hospital. “In fact, we lose about 60 percent of the women who become pregnant and have this disease. And the fetal loss is even higher.”

It is a rare situation – only one in every 100,000 pregnancies.

Maternal-Fetal Medicine specialist Dr. Mark Caine has taken care of only one other case 15 years ago, and the mother died in the week following delivery.

“The big problem with pulmonary hypertension is the mortality rate,” says Dr. Caine. “It’s one of the few conditions where pregnancy is contraindicated.”

Joy’s family rushed her from Altoona to Pittsburgh to see a cardiologist emergently. Her local obstetrician even offered to drive her himself.

She went immediately to the cath lab, where doctors found the blood pressure in her lungs was higher than the pressure in her arm – an extremely dangerous situation that could lead to sudden collapse of circulation.

“Dr. Benza essentially said her pulmonary pressures were one of the highest he’s seen,” Dr. Caine said, “and combined with the pregnancy, his estimate of mortality rate was as high as 90 percent at one point.”

Pulmonary hypertension is a type of high blood pressure that affects the arteries in your lungs and the right side of your heart. As the pressure builds, your heart has to work harder to pump blood through the lungs, causing the heart muscle to weaken and fail. The condition becomes progressively worse and eventually fatal.

From the cath lab, she went to intensive care, where the team tried to get her stabilized with intravenous and inhaled drugs — drugs that typically aren’t used during pregnancy.

“When the doctors come in and was telling me about the chances of us surviving, like the birth and stuff, it was really heart-wrenching,” Joy said.

An ethical dilemma — save Joy or save the baby. She already had a 4-year-old and family counting on her. After much consultation and counseling, Joy, her family, the care team and the ethics committee came to a decision to focus on Joy.

“Our fear was that if the baby really had major distress, where we had to deliver her, that she probably would not make it,” says Dr. Caine. “We were going to do everything to maximize her life, even if it meant sacrificing the little one.”

It would take time to get the medications working optimally to correct Joy’s pressures. Because the pregnancy was aggravating her condition, an early delivery was the plan, but without pushing — because pushing would increase the lung pressures further.

The goal was to get her to 36 weeks, but at 32 weeks, Joy’s water broke and she had a quick, easy delivery in the ICU.

“We were also worried he might be very sick,” says West Penn Hospital neonatologist Dr. Sanjay Mitra. “We thought we might have to put a breathing tube, intubate him, and put him on ventilator. But, he did well. He came out crying, and he continued to do well.”

He was a good size and followed his growth curve to the amazement of the team.

“He is eating well,” Dr. Mitra said, “and from his lung standpoint of view, he’s not on any support, he’s not on any oxygen. I expect he will continue to grow normally and develop normally.”

After a month in the hospital, he’s going home at 36 weeks, earlier than even a full term 40-week baby would. And Joy’s going home with an intravenous tube in her chest and special medicines to control the pressures in her lung vessels.

“It’s just a miracle,” Joy said, “and we’re just glad to be going home today, after being over here for so long.”

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