Pregnancy outcomes of 113 patients with pregnancy complicated with pulmonary hypertension

Pregnancy outcomes of 113 patients with pregnancy complicated with pulmonary hypertension | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pregnancy outcomes of 113 patients with pregnancy complicated with pulmonary hypertension Jiehong Xie, Yafen Wu, Shouping Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7775285/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pregnancy complicated with pulmonary hypertension(PH) is rare but carries great risk. Our aim is to explore the clinical characteristics and anesthesia management experience of pregnant women with PH, and to improve pregnancy outcomes. Methods A retrospective analysis was conducted on the clinical data of 113 pregnant women with PH admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to February 2025 Result Among 113 pregnant women with PH, 13 (11.50%) had idiopathic pulmonary arterial hypertension (IPAH), 32 (28.32%) had PAH complicated with congenital heart disease (CHD-PAH), and 44 (38.94%) had PAH complicated with left heart disease (LHD-PAH). There were 23 (20.35%) of PAH combined with other diseases (oPAH) and 1 (0.88%) of PAH caused by hereditary telangiectasia (HT-PAH). Pregnant women are classified into mild to moderate PH: pulmonary artery systolic pressure (sPAP) of 36-69mmHg (1mmHg = 0.133kPa) and severe PH: sPAP ≥ 70mmHg. 76 (67.26%)in the mild to moderate group and 37(32.74%) in the severe group. Two patients died, with a severe mortality rate of 5.4%. Compared with the mild to moderate PH group, the severe PH group had shorter gestational age, a higher proportion of New York Heart Association (NYHA) heart function grade 3–4 patients, a higher proportion of patients transferred to the intensive care unit (ICU), and longer hospital stays in the ICU. The incidence of perioperative cardiopulmonary complications is relatively high. 97 (85.84%) of patients chose cesarean section(CS), 43 (44.33%) chose general anesthesia, including 21 (56.76%) in the severe group. There were 10 cases (8.85%) of miscarriage and 7 (6.19%) of intrauterine fetal death. The preterm birth rate, low birth weight rate of newborns and neonatal asphyxia rate in the severe group were higher than those in the mild to moderate group. There was 1 (0.88%) of neonatal death in the severe group. Conclusion There are significant differences in pregnancy outcomes among pregnant women with varying degrees of PH. The pregnancy outcomes of patients with mild to moderate pulmonary hypertension are better. General anesthesia, when properly managed, can be safely used for cesarean section in patients with pregnancy complicated with severe pulmonary hypertension. Pulmonary hypertension Pregnancy Pregnancy outcomes Anesthesia Introduction Pulmonary hypertension (PH) refers to a condition where the mean pulmonary artery pressure (MPAP) at rest is higher than 20mmHg, and it is a serious clinical syndrome. The causes of PH are diverse. Different etiologies and pathological mechanisms lead to changes in the structure and function of pulmonary vessels, resulting in increased pulmonary vascular resistance and pulmonary artery pressure (PAP), which in turn causes right heart failure (HF) and even leads to the death of patients. Right heart catheterization for monitoring PAP is the gold standard for the diagnosis of PH [ 1 ]. Clinically, due to their particularity, it is difficult for pregnant women to undergo right heart catheterization monitoring. Usually, color Doppler echocardiography is used to monitor pulmonary artery systolic pressure (sPAP). The incidence of PAP during pregnancy is low, but its mortality rate is extremely high, especially for patients with severe PH, which is one of the high-risk factors for maternal death. Previous studies have shown that the mortality rate of pregnant women with PH is as high as 30–56%, the fetal mortality rate is as high as 3%, and the neonatal mortality rate is as high as 1%. It brings a huge burden to society and families [ 2 ]. It is well known that during pregnancy, the mother's physiology undergoes significant changes. Her blood volume and cardiac output increase significantly, and her coagulation function becomes hyperactive. These changes will significantly increase the burden on the heart. When a pregnant woman has PH, the physiological changes she undergoes may lead to right HF, malignant arrhythmia, pulmonary hypertension crisis and even sudden death. Therefore, severe PH has always been regarded as a contraindication for pregnancy [ 3 ]. However, in recent years, with the development of medical technology and the relaxation of the two-child policy in our country, our hospital, as the critical care maternal center in Guangdong Province, has pregnant women from Guangdong and South China. Every year, we admit pregnant women with PH during pregnancy. Therefore, this study retrospectively analyzed the clinical characteristics and anesthesia management strategies of 113 patients with pregnancy complicated with PH in the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to February 2025, providing a reference for perinatal management. Methods With the approval of the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, by searching the electronic medical record system and the anesthesia information system, a retrospective method was adopted to collect and sort out 113 patients with pregnancy complicated with PH admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to February 2025. Analysis of baseline characteristics (age, weight, gestational weeks, parity), sPAP, etiology, cardiac function, comorbidities, pregnancy outcomes, neonatal outcomes, anesthesia method and other indicators. Diagnostic Criteria The diagnosis of PH: The gold standard for diagnosing PH is the direct measurement of PAP through right heart catheterization, with the MPAP measured at rest being greater than or equal to 20mmHg. As the research subjects of this study were pregnant women, it was difficult to conduct routine right heart catheterization monitoring. All cases were uniformly diagnosed by echocardiography. The sPAP was estimated by the peak velocity of tricuspid regurgitation through echocardiography. sPAP ≥ 35mmHg was defined as PH. PH is classified according to its severity into mild (sPAP between 36 and 49mmHg), moderate (sPAP between 50 and 69mmHg), and severe (sPAP ≥ 70mmHg). In this study, mild and moderate PH were combined into the mild to moderate group. According to the classification method of the New York Heart Association (NYHA) in the United States, cardiac function is divided into four grades. Statistical analysis Data were statistically analyzed using SPSS27.0 software. Measurement data that conformed to a normal distribution were expressed as mean ± standard deviation (mean ± SD), and the independent sample t-test was used for comparison between the two groups. For non-normal distributions, the Mann-Whithey U test is adopted. Counting data were expressed in terms of the number of cases and percentages (%), using the Fisher's exact probability method. Results Baseline Characteristics A total of 113 patients with pregnancy complicated with PH were included in this study. Among them, there were 76 (67.26%) of mild to moderate PH and 37 (32.74%) of severe PH. There were 13 (11.50%) of IPAH, 32 (28.32%) of CHD-PAH, 44 (38.94%) of LHD-PAH, 23 (20.35%) of oPAH, and 1 (0.88%) of PAH caused by hereditary telangiectasia(HT-PAH)( Table 1 ). Table 1 Pathogenesis of pregnancy complicated with pulmonary hypertension Pathogenesis of PH Mild to moderate PAH(n = 76) Severe PAH(n = 37) Total(n = 113) IPAH,n(%) 6(7.89) 7(18.92) 13(11.5) CHD-PAH ,n(%) 17(22.37) 15(40.54) 32(28.32) LHD-PH,n(%) 35(46.05) 9(24.32) 44(38.94) oPAH,n(%) 18(23.68) 5(13.51) 23(20.35) HT-PAH,n(%) 0(0.00) 1(2.70) 1(0.88) IPAH :Idiopathic pulmonary arterial hypertension, CHD-PAH :Pulmonary arterial hypertension complicated with congenital heart disease, LHD-PAH :Pulmonary arterial hypertension complicated with left heart disease,oPAH: Pulmonary arterial hypertension combined with other diseases,HT-PAH: Pulmonary arterial hypertension caused by hereditary telangiectasia. The patients' ages ranged from 19 to 46 years, with an average of (31.77 ± 6.23) year. The body weight ranged from 41 to 111kg, with an average of (63.48 ± 11.70) kg. There was no significant statistical difference in age and body weight between the two groups of patients. There were 42 (37.17%) of first labor, among which 30 (39.47%) were in the mild to moderate group and 12 (32.43%) were in the severe group. The gestational weeks of the patients ranged from 3 to 39 weeks, with an average of (31.54 ± 7.85) weeks. The PAP ranged from 36 to 148mmHg, with an average of (58.91 ± 25.15) mmHg. There were statistically significant differences in gestational age and PAP between the two groups of patients. The average gestational age of patients in the mild to moderate group was (33.22 ± 6.80) weeks, and that of patients in the severe group was (28.08 ± 8.80) weeks. The sPAP of patients in the mild to moderate group was (43.63 ± 9.39) mmHg, and that of patients in the severe group was (90.46 ± 16.11) mmHg, indicating that as the pulmonary artery rose, the gestational age of the patients shortened. There was a statistically significant difference between the two groups of patients with cardiac function at grades 3–4. There were 11 patients (14.47%) with grade 3–4 cardiac function in the mild to moderate group and 20 patients (54.05%) in the severe group. The proportion of patients with grade 3–4 cardiac function in the severe group was relatively high, indicating that the cardiac function of patients deteriorated with the increase of sPAP(Table 2 ). Table 2 Basic information of patients Indicator Mild to moderate PAH(n = 76) Severe PAH(n = 37) Total(n = 113) p- value Age(years, mean ± SD) 32.30 ± 5.54 30.68 ± 7.43 31.77 ± 6.23 0.095 Weight(kg, mean ± SD) 63.83 ± 11.88 60.71 ± 10.96 63.48 ± 11.70 0.079 Primiparity(n, %) 30(39.47%) 12(32.43%) 42(37.17%) 0.0467 Gestational weeks(w, mean ± SD) 33.22 ± 6.80 28.08 ± 8.80 31.54 ± 7.85 < 0.001 Pulmonary artery pressure(mmHg, mean ± SD) 43.63 ± 9.39 90.46 ± 16.11 58.91 ± 25.15 < 0.001 NYHA cardiac function (n, %) < 0.001 1ཞ 2 65(85.53%) 17(45.95%) 82(72.57%) 3ཞ 4 11(14.47%) 20(54.05%) 31(27.43%) NYHA :New York Heart Association. Maternal outcomes In this study, a total of 50 patients (44.25%) were transferred to the ICU, among which 17 (22.37%) were mild to moderate and 33 (89.19%) were severe. The duration of stay in the ICU for patients transferred to the ICU ranged from 1 to 53 days, with an average of (8.34 ± 9.37) days. There were statistically significant differences in the transfer to the ICU and the duration of stay between the two groups. Compared with the mild to moderate group, the severe group had more patients transferred to the ICU and a longer duration of stay in the ICU. In this study, a total of 97 (85.84%) of patients chose cesarean section (CS), while only 2 (1.77%) had natural delivery. There was no significant statistical difference in the choice of delivery mode between the two groups of patients. For patients undergoing CS, 43 (44.33%) chose general anesthesia, among which 22 (28.95%) were in the mild to moderate group and 21 (56.76%) were in the severe group. A total of 54 (55.67%) of patients received intraspinal anesthesia, including 47 (61.84%) in the mild to moderate group and 7 (18.92%) in the severe group. There was a significant statistical difference in the choice of anesthesia methods between the two groups of patients undergoing CS. Mild to moderate patients were more inclined to choose intraspinal anesthesia, while the proportion of patients with severe conditions choosing general anesthesia was higher. Cardiopulmonary complications occurred in 57 (50.44%) of patients, including Eisenmenger syndrome, Pulmonary embolism, Heart failure, Pericardial effusion, Arrhythmia, Pulmonary edema, Pulmonary infection and Multiple organ dysfunction syndrome (MODS). There was a significant statistical difference in complications between the two groups of patients. Severe patients were more prone to complications. Among the 37 severe patients, only 9 (24.32%) had no complications (Table 3 ). Table 3 Pregnancy outcomes Indicator Mild to moderate PAH(n = 76) Severe PAH(n = 37) Total(n = 113) p- value Maternal outcomes Transferred to the ICU(n, %) 17(22.37%) 33(89.19%) 50(44.25%) < 0.001 Length of stay in the ICU(d, mean ± SD) 5.18 ± 4.37 10.00 ± 10.80 8.34 ± 9.37 0.046 Delivery mode ( n, % ) 0.502 Csarean section 69(90.79%) 28(75.68%) 97(85.84%) Natural delivery 1(1.32%) 1(2.70%) 2(1.77%) Anesthesia methods ( n, % ) < 0.001 General anesthesia 22(28.95%) 21(56.76%) 43(44.33%) Intraspinal anesthesia 47(61.84%) 7(18.92%) 54(55.67%) Complications(n, %) 29(38.16%) 28(75.68%) 57(50.44%) < 0.001 Neonatal outcomes Miscarriage(n, %) 6(7.89%) 4(10.81%) 10(8.85%) 0.873 Stillbirth(n,%) 3(3.95%) 4(10.81%) 7(6.19%) 0.214 Premature delivery(n,%) 32(42.11%) 23(62.16%) 55(58.51%) < 0.001 Low birth weight of newborns(n,%) 33(43.42%) 20(54.05%) 53(56.38%) 0.639 Neonatal asphyxia(n,%) 8(11.94%) 13(48.15%) 21(22.34%) < 0.001 Weight of the newborns(kg, mean ± SD) 2455.45 ± 716.70 1793 ± 707.12 2260.20 ± 772.32 < 0.001 Neonatal death(n, %) 0(0) 1(3.57%) 1(1.05%) 0.302 ICU:Intensive Care Unit In this study, 2 patients died, with a mortality rate of 1.77%. Both were severe patients, and the mortality rate of severe patients was 5.4%. Among them, one patient had IPH. This patient did not have regular prenatal check-ups. During the examination at another hospital, the patient was transferred to our hospital due to severe PH. After the patient was transferred to our hospital, a CS was performed after multidisciplinary consultation and assessment. During the operation, the patient experienced two cardiac arrests due to the pulmonary hypertension crisis. Despite active rescue efforts through multidisciplinary consultation, the patient still died. The cause of the other case was congenital heart disease. The patient had irregular prenatal check-ups in another hospital and was transferred to our hospital due to a decrease in blood oxygen saturation. After a multidisciplinary consultation and assessment, the patient was prepared to be sent to the operating room for laparotomy and CS for fetal removal. During the preparation period, the patient experienced rapid breathing and the blood oxygen saturation could not be maintained. Immediate rescue was carried out and a stillborn fetus was pulled from the buttocks. Despite all-out rescue efforts, the patient's condition deteriorated further and he died two days later (Table 4 ). Table 4 Information on deceased patients Case 1 Case 2 Age(years) 24 35 gestational weeks(w) 33 30 parity G2P1 G1P0 Pathogenesis IPAH CHD pulmonary artery pressure(mmHg) 115 148 Regular prenatal check-ups NO NO Initial symptom Shortness of breath Coughing and runny nose, SPO2 reduce NYHA cardiac function GradeIII GradeIV complication Right heart failure, MODS Right heart failure, SPO2 reduce, PHC, MODS Neonatal outcomes survive stillbirth Delivery mode Csarean section Natural delivery Anesthesia methods Intraspinal anesthesia NO Death time 1 day after delivery 2 day after delivery Neonatal Outcomes In this study, there were 10 (8.85%) of miscarriage, among which 6 (7.89%) were in the mild to moderate group and 4 (10.81%) were in the severe group. There were 7 (6.19%) of intrauterine fetal death, 3 (3.95%) in the mild to moderate group and 4 (10.81%) in the severe group. There was no statistically significant difference in the miscarriage rate and stillbirth rate between the two groups of patients. However, with the increase of PAP, the proportion of miscarriage and stillbirth in pregnant women increased. There was 1 (1.05%) of neonatal death, and the mother was a patient in the severe group. A total of 113 pregnant women gave birth to 94 (83.14%) surviving newborns. Among them, 55 (58.51%) were premature infants. 32 (42.11%) had mothers with mild to moderate PH, and 23 (62.16%) had mothers with severe PH. There was a significant statistical difference in the preterm birth rate of newborns between the two groups of patients. Among the surviving newborns, 53 (56.38%) had low birth weight, 33 (43.42%) were in the mild to moderate group, and 20 (54.05%) were in the severe group. There was a statistically significant difference in the low birth weight of newborns between the two groups, and patients with severe PH were more likely to have low birth weight of newborns. The weight of the newborns was significantly lower than that of the mild to moderate group. 21 (22.34%) of newborns had asphyxia, among which 8 (11.94%) were in the mild to moderate group and 13 (48.15%) were in the severe group. Compared with the mild to moderate group, newborns in the severe group were more prone to asphyxia, and the difference was statistically significant(Table 3 ). Discussion PH during pregnancy is a disease that can threaten the lives of pregnant and postpartum women and is caused by multiple factors. In this study, CHD-PAH and LHD-PH accounted for the highest proportions. PH during pregnancy is extremely rare, but the maternal mortality rate is very high, as are the rates of preterm birth and mortality of fetuses. PH is classified as mWHO Category 4 in the revised World Health Organization maternal (mWHO) cardiovascular risk classification [ 4 ]. Therefore, patients with PH are often prohibited from getting pregnant [ 3 ]. With the advancement of medical technology, the application of targeted drugs and multidisciplinary interventional comprehensive diagnosis and treatment, studies have shown that the pregnancy outcomes of patients with mild PH during pregnancy have significantly improved under close monitoring and multidisciplinary comprehensive treatment [ 5 ]. PH during pregnancy is not an absolute contraindication [ 6 ].However, for patients with pregnancy complicated with severe PH, the mortality rate remains high. It is still recommended that patients with severe PH refrain from pregnancy. The principle of individualized diagnosis and treatment should be adopted for patients with pregnancy complicated with PH [ 7 ]. Therefore, in this study, mild PH and moderate PH were combined into one group and compared with severe PH to analyze the maternal and infant outcomes of patients with different degrees of PH during pregnancy. This study shows that the prognosis of patients with pregnancy complicated with different degrees of PH varies. Among the 113 patients, 2 died, with a mortality rate of 1.77%. Both of the 2 patients were severe PH patients, and the mortality rate of severe cases was 5.4%, which was much lower than that reported in the literature [ 8 ]. The possible reason is that our hospital, as the Guangdong Provincial Center for Critical Pregnant Women, has accumulated certain experience in the treatment of critical pregnant women. Among the two deceased patients, one was caused by IPAH and the other by congenital heart disease. Literature reports that IPAH is the most dangerous with an extremely high mortality rate [ 9 ]. As the PAP increased, the cardiac function classification of the patients became higher. The cardiac functions of the two deceased patients were both grade 3–4, and both suffered from heart failure and MODS. Despite active rescue efforts, they eventually died. Previous studies have shown that grade 3–4 cardiac function is an independent factor for adverse pregnancy outcomes in pregnancy complicated with PH [ 10 ]. Our research shows that with the increase of PAP, the proportion of patients with PH during pregnancy whose cardiac function is at grade 3–4 is relatively high. During pregnancy and childbirth, a series of physiological changes occur in women, with increased blood volume and cardiac output, and a heavier burden on the heart. As the gestational weeks increase, the changes in maternal blood volume and hemodynamics become more obvious, and the cardiac load brought by pregnancy becomes more severe. Healthy women can adapt to this physiological change. However, in patients with pregnancy complicated with PH, the physiological changes brought about by pregnancy can further exacerbate PH, making them prone to cardiopulmonary complications and leading to disastrous consequences [ 11 ]. In our study, the gestational weeks of patients with different degrees of PH were different. There were significant statistical differences between patients with mild to moderate PH and those with severe PH. The gestational weeks of patients with severe PH were significantly shortened, indicating that as the PAP increased, patients were less adaptable to the physiological changes brought about by pregnancy and were more prone to complications. Compared with patients with mild to moderate PH, those with severe PH during pregnancy are more likely to have complications such as Eisenmenger syndrome, Pulmonary embolism, Heart failure, Pericardial effusion, Arrhythmia, Pulmonary edema, Pulmonary infection and MODS. Therefore, for pregnancy complicated with severe PH, it is usually recommended to avoid getting pregnant. For patients who are already pregnant, it is also recommended to terminate the pregnancy early. Once pregnancy is maintained, it is recommended to choose CS for delivery in the middle and late stages. CS can quickly end the pregnancy, avoid the increase in blood return to the heart caused by uterine contractions, and at the same time reduce the increase in cardiac load caused by uterine contraction pain. It is the preferred delivery method for pregnancy complicated with PH [ 12 ]. Among the patients in our study this time, only two chose natural delivery, while the rest all opted for CS. For patients undergoing CS, perioperative management is of vital importance. Preoperative multidisciplinary consultation, selection and management of anesthesia, and admission to the ICU for comprehensive monitoring and treatment can improve maternal and infant outcomes [ 13 ]. In our study, a total of 50 patients (44.25%) were transferred to the ICU, among which 17 (22.37%) were mild to moderate and 33 (89.19%) were severe. There were statistically significant differences in the transfer to the ICU and the duration of stay in the ICU between the two groups of patients. The severe group had more patients transferred to the ICU and a longer duration of stay in the ICU. Both general anesthesia and intraspinal anesthesia have been reported to be used in pregnancy complicated with PH, but there is no consensus on which anesthesia method to choose [ 14 ]. General anesthesia, due to its definite anesthetic effect, significant analgesic, sedative and muscle relaxation effects, inhibits the excitation of the sympathetic nerve in patients, thereby reducing the occurrence of acute pulmonary edema, and at the same time can better provide oxygenation. Intraspinal anesthesia can cause the blood vessels in the blocked area of the sympathetic nerve of the patient to dilate, thereby reducing peripheral vascular resistance, decreasing return blood volume, making circulation more stable, and at the same time reducing the preload of the right heart of the patient, decreasing myocardial oxygen consumption, and lowering the risk of pulmonary infection caused by endotracheal intubation in the patient [ 15 – 16 ]. In our current study, 43 patients (44.33%) who underwent CS chose general anesthesia, among which 22 (28.95%) were in the mild to moderate group and 21 (56.76%) were in the severe group. A total of 54 (55.67%) of patients received intraspinal anesthesia, including 47 (61.84%) in the mild to moderate group and 7 (18.92%) in the severe group. There was a significant statistical difference in the choice of anesthesia methods between the two groups of patients undergoing CS. Patients with mild to moderate conditions were more inclined to choose intraspinal anesthesia, while those with severe conditions had a higher proportion of choosing general anesthesia. General anesthesia can be safely used for CS in patients with pregnancy complicated with severe PH, especially when complications occur during the operation, it is more convenient to treat patients under general anesthesia. Hemodynamics is easier to control. Among our patients, there was one who developed pulmonary embolism during a CS. Through our efforts in rescue, the patient eventually recovered and was discharged from the hospital. We have previously reported this case [ 17 ]. Fetuses of patients with PH during pregnancy are more prone to adverse outcomes, with a higher risk of premature birth, low birth weight of newborns, and fetal and neonatal death [ 18 – 19 ]. In our current study, there were 10 (8.85%) of miscarriage, 7 (6.19%) of intrauterine fetal death, and 1 (1.05%) of neonatal death. The deceased newborns were born to patients in the severe group. There was no statistically significant difference in the miscarriage rate and stillbirth rate between the two groups of patients. However, with the increase of PAP, the proportion of miscarriage and stillbirth in pregnant women increased. Our research shows that the premature birth rate of newborns is 58.51%. The proportion of premature births among pregnant women with different degrees of PH varies. 42.11% of the fetuses in the mild to moderate group were premature, which is lower than 62.16% in the severe group. Among the surviving newborns, 56.38% had low birth weight and 22.34% had asphyxia. There were statistically significant differences in the rates of low birth weight and asphyxia between the two groups of patients. The fetal outcomes in the mild to moderate group were better than those in the mild group. In this study, the neonatal mortality rate was lower than that reported in the literature [ 20 ], indicating that proper perinatal management can significantly improve the pregnancy outcomes of patients with pregnancy complicated with PH. Study limitations This study has certain limitations. This is a single center retrospective study, and there may be some bias in the study population and results. In addition, the diagnostic criterion for PH is right cardiac catheterization. As the study subjects were pregnant women, echocardiography was used for diagnosis, and there may be some deviation in the results. Conclusion In summary, the mortality rate of patients with PH during pregnancy is extremely high and it is a contraindication for pregnancy. However, with proper perinatal management, early warning and termination of pregnancy when necessary, patients with mild to moderate PH can still be safe. For patients undergoing CS, those with mild to moderate conditions can choose intraspinal anesthesia, while for those with severe conditions, general anesthesia is more conducive to intraoperative management. If general anesthesia is properly managed, it can be safely used for CS in patients with pregnancy complicated with severe PH. Abbreviations PH Pulmonary hypertension IPAH Idiopathic pulmonary arterial hypertension CHD-PAH PAH complicated with congenital heart disease LHD-PAH PAH complicated with left heart disease oPAH PAH combined with other diseases HT-PAH PAH caused by hereditary telangiectasia sPAP Pulmonary artery systolic pressure NYHA New York Heart Association ICU Intensive care unit CS Cesarean section MPAP Mean pulmonary artery pressure PAP Pulmonary artery pressure HF Heart failure MODS Multiple organ dysfunction syndrome mWHO World Health Organization maternal Declarations Authors’ contributions Jiehong Xie: Study Design, Methodology, Collect data,Statistical analysis, Supervision, Project administration,Manuscript Preparation & editing.Yafen Wu: Collect data,Statistical analysis.Shouping Wang: Study Design, Methodology, Supervision, Project administration,Manuscript review and revision, Funding acquisition. Funding 1. Key Health Research Project of Liwan District Science and Technology Plan (NO: 202201011); 2. Basic and Applied Basic Project of Guangdong Provincial Department of Science and Technology (NO: 2021A1515220002); 3. Clinical Characteristic Technology Construction Project of Guangzhou Health Commission in 2023 (NO: 2023C-TS55). Availability of data and materials All data supporting the results of this study are available from the corresponding author upon request. Ethics approval and consent to participate This study has been approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University. According to the ethical standards of the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, this study applied for exemption from informed consent. All studies conducted in this study comply with the ethical standards of the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University and the 1964 Helsinki Declaration and its subsequent revisions or similar ethical standards. Clinicl trial number Not applicable. Consent for publication Not applicable. Conflicts of Interest There are no conflicts of interest. References Mocumbi A, Humbert M, Saxena A et al. Pulmonary hypertension. Nat Rev Dis Primers. 2024;10(1):1. Erratum in: Nat Rev Dis Primers. 2024;10(1):5. Low TT, Guron N, Ducas R, et al. Pulmonary arterial hypertension in pregnancy-a systematic review of outcomes in the modern era. Pulm Circ. 2021;11(2):20458940211013671. Hemnes AR, Kiely DG, Cockrill BA, et al. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute. Pulm Circ. 2015;5(3):435–65. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2023;61(1):2200879. Corbach N, Berlier C, Lichtblau M, et al. Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension. Front Med (Lausanne). 2021;8:689764. Piao C, Wang WJ, Deng Y, et al. Clinical outcomes of pulmonary hypertension in pregnancy among women with congenital heart disease in China. J Matern Fetal Neonatal Med. 2023;36(1):2183349. Martin SR, Edwards A. Pulmonary Hypertension and Pregnancy. Obstet Gynecol. 2019;134(5):974–987.Erratum in: Obstet Gynecol. 2020;135(4):978. Hemnes AR, Kiely DG, Cockrill BA, et al. Statement on pregnancy in pulmonary hypertension from the pulmonaryvascular research institute. Pulm Circ. 2015;5(3):435–65. Rashidi F, Sate H. Pregnancy outcome in a pregnant patient with idiopathic Pulmonary Arterial Hypertension: a case report and review of the literature. J Med Case Rep. 2018;12(1):31. Dai Q, Shang M, Zhou Y, et al. Evaluation of maternal-fetal outcomes in pregnancy complicated with severe pulmonary hypertension and its influencing factors: a single-center retrospective study in China. J Matern Fetal Neonatal Med. 2023;36(2):2290923. Pan J, Wu Q, Chen S, et al. Clinical outcomes of pregnancy in patients with pulmonary hypertension: A single center observational study. J Cardiothorac Surg. 2025;20(1):199. Teng Y, Zong L, Ding J, et al. Management of pulmonary arterial hypertension: before, during and after pregnancy. Int J Cardiol Cardiovasc Risk Prev. 2024;21:200252. Shu T, Feng P, Liu X, et al. Multidisciplinary Team Managements and Clinical Outcomes in Patients With Pulmonary Arterial Hypertension During the Perinatal Period. Front Cardiovasc Med. 2021;8:795765. fcvm.2021.795765. Ming Y, Wu Z, Wu Z, et al. Effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension: a meta-analysis. Arch Gynecol Obstet. 2022;306(1):7–15. Epub 2021. Idehen HO, Amadasun FE, Ekwere IT. Comparison of intravenous colloid and colloid-crystalloid combination in hypotension prophylaxis during spinal anesthesia for cesarean section. Niger J Clin Pract. 2014;17(3):309–13. Behdad S, Hajiesmaeili MR, Abbasi HR, et al. Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial. Anesth Pain Med. 2013;3(2):230–3. Epub 2013. Chen W, Liang P, Zhan H, et al. Pulmonary embolism during cesarean section in a patient with severe pulmonary hypertension. Int J Gynaecol Obstet. 2022;157(1):200–1. Liu Y, Li Y, Zhang J, et al. Pregnancy complications and outcomes among women with congenital heart disease in Beijing China. Front Cardiovasc Med. 2021;8:765004. Sliwa K, van Hagen IM, Budts W, et al. Pulmonary hypertension and pregnancy outcomes: data from the registry of pregnancy and cardiac disease (ROPAC) of the European Society of Cardiology. Eur J Heart Fail. 2016;18(9):1119–28. Pan J, Wu Q, Chen S, et al. Clinical outcomes of pregnancy in patients with pulmonary hypertension: A single center observational study. J Cardiothorac Surg. 2025;20(1):199. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7775285","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":538739428,"identity":"6072b8d4-7552-4637-80ff-7bfc094378d7","order_by":0,"name":"Jiehong Xie","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiehong","middleName":"","lastName":"Xie","suffix":""},{"id":538739429,"identity":"8502c66d-d76a-43bc-a349-90fa5f39ff15","order_by":1,"name":"Yafen Wu","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yafen","middleName":"","lastName":"Wu","suffix":""},{"id":538739430,"identity":"38cbfa3f-2144-4d06-8136-e55031073862","order_by":2,"name":"Shouping Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIiWNgGAWjYLACxgYgwQzEHypsEsAiCQVEamGccSYtgYENpMWAGC0gXZwthyFaGPBoMTh+9vDLnztsErez8x5+zdhwPo9fvjvxwwMDBnl+sQPYtZzJS7PmPZOWuLOZL826cMftYsk23s0SQIcZzpydgFWL2YEcM2PGtsOJGw7zmBnPPHM7ccMx3g0gLQkGt3FoOf/GzPAnTAtv2zmQls0/8Gq5kWP8gBeixfgxb9sBkJZteG2xv/HGjJm3Lc14ZzOPGTCQkxNntuVus0gwkMDpF8n+HOOPP9tsZLfznzH+8KHCLrGf+ezmmz8qbOT5pbFrAQI2CXDQwRhQIIFDNRgwf4BqgTBGwSgYBaNgFKADADQGZ5wKod0TAAAAAElFTkSuQmCC","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shouping","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-10-03 17:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7775285/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7775285/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95147138,"identity":"12a552b7-105a-4278-9dc1-a0ff13b309dd","added_by":"auto","created_at":"2025-11-04 19:26:52","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":46980,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7775285/v1/cb20b46758d5fe3f06047a93.docx"},{"id":95147140,"identity":"a27d2d32-f42b-4498-bdb0-8a28d67cf451","added_by":"auto","created_at":"2025-11-04 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07:56:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":680220,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7775285/v1/df3714c1-920e-4dc9-be22-d19b13809c89.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pregnancy outcomes of 113 patients with pregnancy complicated with pulmonary hypertension","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePulmonary hypertension (PH) refers to a condition where the mean pulmonary artery pressure (MPAP) at rest is higher than 20mmHg, and it is a serious clinical syndrome. The causes of PH are diverse. Different etiologies and pathological mechanisms lead to changes in the structure and function of pulmonary vessels, resulting in increased pulmonary vascular resistance and pulmonary artery pressure (PAP), which in turn causes right heart failure (HF) and even leads to the death of patients. Right heart catheterization for monitoring PAP is the gold standard for the diagnosis of PH [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Clinically, due to their particularity, it is difficult for pregnant women to undergo right heart catheterization monitoring. Usually, color Doppler echocardiography is used to monitor pulmonary artery systolic pressure (sPAP). The incidence of PAP during pregnancy is low, but its mortality rate is extremely high, especially for patients with severe PH, which is one of the high-risk factors for maternal death. Previous studies have shown that the mortality rate of pregnant women with PH is as high as 30\u0026ndash;56%, the fetal mortality rate is as high as 3%, and the neonatal mortality rate is as high as 1%. It brings a huge burden to society and families [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIt is well known that during pregnancy, the mother's physiology undergoes significant changes. Her blood volume and cardiac output increase significantly, and her coagulation function becomes hyperactive. These changes will significantly increase the burden on the heart. When a pregnant woman has PH, the physiological changes she undergoes may lead to right HF, malignant arrhythmia, pulmonary hypertension crisis and even sudden death. Therefore, severe PH has always been regarded as a contraindication for pregnancy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, in recent years, with the development of medical technology and the relaxation of the two-child policy in our country, our hospital, as the critical care maternal center in Guangdong Province, has pregnant women from Guangdong and South China. Every year, we admit pregnant women with PH during pregnancy. Therefore, this study retrospectively analyzed the clinical characteristics and anesthesia management strategies of 113 patients with pregnancy complicated with PH in the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to February 2025, providing a reference for perinatal management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e With the approval of the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, by searching the electronic medical record system and the anesthesia information system, a retrospective method was adopted to collect and sort out 113 patients with pregnancy complicated with PH admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to February 2025. Analysis of baseline characteristics (age, weight, gestational weeks, parity), sPAP, etiology, cardiac function, comorbidities, pregnancy outcomes, neonatal outcomes, anesthesia method and other indicators.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDiagnostic Criteria\u003c/h2\u003e\u003cp\u003eThe diagnosis of PH: The gold standard for diagnosing PH is the direct measurement of PAP through right heart catheterization, with the MPAP measured at rest being greater than or equal to 20mmHg. As the research subjects of this study were pregnant women, it was difficult to conduct routine right heart catheterization monitoring. All cases were uniformly diagnosed by echocardiography. The sPAP was estimated by the peak velocity of tricuspid regurgitation through echocardiography. sPAP\u0026thinsp;\u0026ge;\u0026thinsp;35mmHg was defined as PH. PH is classified according to its severity into mild (sPAP between 36 and 49mmHg), moderate (sPAP between 50 and 69mmHg), and severe (sPAP\u0026thinsp;\u0026ge;\u0026thinsp;70mmHg). In this study, mild and moderate PH were combined into the mild to moderate group. According to the classification method of the New York Heart Association (NYHA) in the United States, cardiac function is divided into four grades.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData were statistically analyzed using SPSS27.0 software. Measurement data that conformed to a normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), and the independent sample t-test was used for comparison between the two groups. For non-normal distributions, the Mann-Whithey U test is adopted. Counting data were expressed in terms of the number of cases and percentages (%), using the Fisher's exact probability method.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eBaseline Characteristics\u003c/h2\u003e\u003cp\u003eA total of 113 patients with pregnancy complicated with PH were included in this study. Among them, there were 76 (67.26%) of mild to moderate PH and 37 (32.74%) of severe PH. There were 13 (11.50%) of IPAH, 32 (28.32%) of CHD-PAH, 44 (38.94%) of LHD-PAH, 23 (20.35%) of oPAH, and 1 (0.88%) of PAH caused by hereditary telangiectasia(HT-PAH)( Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePathogenesis of pregnancy complicated with pulmonary hypertension\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathogenesis of PH\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild to moderate PAH(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSevere PAH(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIPAH,n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6(7.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7(18.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13(11.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHD-PAH ,n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(22.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15(40.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32(28.32)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLHD-PH,n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35(46.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9(24.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44(38.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eoPAH,n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18(23.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(13.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23(20.35)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHT-PAH,n(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0(0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1(0.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eIPAH :Idiopathic pulmonary arterial hypertension, CHD-PAH :Pulmonary arterial hypertension complicated with congenital heart disease, LHD-PAH :Pulmonary arterial hypertension complicated with left heart disease,oPAH: Pulmonary arterial hypertension combined with other diseases,HT-PAH: Pulmonary arterial hypertension caused by hereditary telangiectasia.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe patients' ages ranged from 19 to 46 years, with an average of (31.77\u0026thinsp;\u0026plusmn;\u0026thinsp;6.23) year. The body weight ranged from 41 to 111kg, with an average of (63.48\u0026thinsp;\u0026plusmn;\u0026thinsp;11.70) kg. There was no significant statistical difference in age and body weight between the two groups of patients. There were 42 (37.17%) of first labor, among which 30 (39.47%) were in the mild to moderate group and 12 (32.43%) were in the severe group. The gestational weeks of the patients ranged from 3 to 39 weeks, with an average of (31.54\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85) weeks. The PAP ranged from 36 to 148mmHg, with an average of (58.91\u0026thinsp;\u0026plusmn;\u0026thinsp;25.15) mmHg. There were statistically significant differences in gestational age and PAP between the two groups of patients. The average gestational age of patients in the mild to moderate group was (33.22\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80) weeks, and that of patients in the severe group was (28.08\u0026thinsp;\u0026plusmn;\u0026thinsp;8.80) weeks. The sPAP of patients in the mild to moderate group was (43.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.39) mmHg, and that of patients in the severe group was (90.46\u0026thinsp;\u0026plusmn;\u0026thinsp;16.11) mmHg, indicating that as the pulmonary artery rose, the gestational age of the patients shortened. There was a statistically significant difference between the two groups of patients with cardiac function at grades 3\u0026ndash;4. There were 11 patients (14.47%) with grade 3\u0026ndash;4 cardiac function in the mild to moderate group and 20 patients (54.05%) in the severe group. The proportion of patients with grade 3\u0026ndash;4 cardiac function in the severe group was relatively high, indicating that the cardiac function of patients deteriorated with the increase of sPAP(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBasic information of patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild to moderate PAH(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSevere PAH(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.68\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.77\u0026thinsp;\u0026plusmn;\u0026thinsp;6.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight(kg, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.71\u0026thinsp;\u0026plusmn;\u0026thinsp;10.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.48\u0026thinsp;\u0026plusmn;\u0026thinsp;11.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimiparity(n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30(39.47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(32.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42(37.17%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0467\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational weeks(w, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.22\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.08\u0026thinsp;\u0026plusmn;\u0026thinsp;8.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.54\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePulmonary artery pressure(mmHg, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90.46\u0026thinsp;\u0026plusmn;\u0026thinsp;16.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58.91\u0026thinsp;\u0026plusmn;\u0026thinsp;25.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNYHA cardiac function (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1ཞ 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65(85.53%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(45.95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82(72.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3ཞ 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(14.47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(54.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31(27.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNYHA :New York Heart Association.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMaternal outcomes\u003c/h3\u003e\n\u003cp\u003eIn this study, a total of 50 patients (44.25%) were transferred to the ICU, among which 17 (22.37%) were mild to moderate and 33 (89.19%) were severe. The duration of stay in the ICU for patients transferred to the ICU ranged from 1 to 53 days, with an average of (8.34\u0026thinsp;\u0026plusmn;\u0026thinsp;9.37) days. There were statistically significant differences in the transfer to the ICU and the duration of stay between the two groups. Compared with the mild to moderate group, the severe group had more patients transferred to the ICU and a longer duration of stay in the ICU. In this study, a total of 97 (85.84%) of patients chose cesarean section (CS), while only 2 (1.77%) had natural delivery. There was no significant statistical difference in the choice of delivery mode between the two groups of patients. For patients undergoing CS, 43 (44.33%) chose general anesthesia, among which 22 (28.95%) were in the mild to moderate group and 21 (56.76%) were in the severe group. A total of 54 (55.67%) of patients received intraspinal anesthesia, including 47 (61.84%) in the mild to moderate group and 7 (18.92%) in the severe group. There was a significant statistical difference in the choice of anesthesia methods between the two groups of patients undergoing CS. Mild to moderate patients were more inclined to choose intraspinal anesthesia, while the proportion of patients with severe conditions choosing general anesthesia was higher. Cardiopulmonary complications occurred in 57 (50.44%) of patients, including Eisenmenger syndrome, Pulmonary embolism, Heart failure, Pericardial effusion, Arrhythmia, Pulmonary edema, Pulmonary infection and Multiple organ dysfunction syndrome (MODS). There was a significant statistical difference in complications between the two groups of patients. Severe patients were more prone to complications. Among the 37 severe patients, only 9 (24.32%) had no complications (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePregnancy outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild to moderate PAH(n\u0026thinsp;=\u0026thinsp;76)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSevere PAH(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal outcomes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransferred to the ICU(n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17(22.37%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33(89.19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50(44.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of stay in the ICU(d, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.34\u0026thinsp;\u0026plusmn;\u0026thinsp;9.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDelivery mode\u003c/b\u003e(\u003cb\u003en, %\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.502\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCsarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69(90.79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28(75.68%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e97(85.84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNatural delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(1.32%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(2.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2(1.77%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAnesthesia methods\u003c/b\u003e(\u003cb\u003en, %\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral anesthesia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(28.95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21(56.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43(44.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraspinal anesthesia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47(61.84%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7(18.92%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e54(55.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplications(n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(38.16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28(75.68%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57(50.44%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNeonatal outcomes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiscarriage(n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(7.89%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(10.81%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10(8.85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.873\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStillbirth(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(3.95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(10.81%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7(6.19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.214\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePremature delivery(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32(42.11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23(62.16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55(58.51%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow birth weight of newborns(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33(43.42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20(54.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e53(56.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.639\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal asphyxia(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(11.94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13(48.15%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21(22.34%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight of the newborns(kg, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2455.45\u0026thinsp;\u0026plusmn;\u0026thinsp;716.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1793\u0026thinsp;\u0026plusmn;\u0026thinsp;707.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2260.20\u0026thinsp;\u0026plusmn;\u0026thinsp;772.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal death(n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(3.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1(1.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.302\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eICU:Intensive Care Unit\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn this study, 2 patients died, with a mortality rate of 1.77%. Both were severe patients, and the mortality rate of severe patients was 5.4%. Among them, one patient had IPH. This patient did not have regular prenatal check-ups. During the examination at another hospital, the patient was transferred to our hospital due to severe PH. After the patient was transferred to our hospital, a CS was performed after multidisciplinary consultation and assessment. During the operation, the patient experienced two cardiac arrests due to the pulmonary hypertension crisis. Despite active rescue efforts through multidisciplinary consultation, the patient still died. The cause of the other case was congenital heart disease. The patient had irregular prenatal check-ups in another hospital and was transferred to our hospital due to a decrease in blood oxygen saturation. After a multidisciplinary consultation and assessment, the patient was prepared to be sent to the operating room for laparotomy and CS for fetal removal. During the preparation period, the patient experienced rapid breathing and the blood oxygen saturation could not be maintained. Immediate rescue was carried out and a stillborn fetus was pulled from the buttocks. Despite all-out rescue efforts, the patient's condition deteriorated further and he died two days later (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInformation on deceased patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCase 2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egestational weeks(w)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eparity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eG2P1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eG1P0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathogenesis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIPAH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCHD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epulmonary artery pressure(mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegular prenatal check-ups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInitial symptom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShortness of breath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCoughing and runny nose, SPO2 reduce\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNYHA cardiac function\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGradeIII\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGradeIV\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ecomplication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRight heart failure, MODS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRight heart failure, SPO2 reduce, PHC, MODS\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal outcomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003esurvive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003estillbirth\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelivery mode\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCsarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNatural delivery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnesthesia methods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntraspinal anesthesia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNO\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 day after delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 day after delivery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eNeonatal Outcomes\u003c/h2\u003e\u003cp\u003eIn this study, there were 10 (8.85%) of miscarriage, among which 6 (7.89%) were in the mild to moderate group and 4 (10.81%) were in the severe group. There were 7 (6.19%) of intrauterine fetal death, 3 (3.95%) in the mild to moderate group and 4 (10.81%) in the severe group. There was no statistically significant difference in the miscarriage rate and stillbirth rate between the two groups of patients. However, with the increase of PAP, the proportion of miscarriage and stillbirth in pregnant women increased. There was 1 (1.05%) of neonatal death, and the mother was a patient in the severe group. A total of 113 pregnant women gave birth to 94 (83.14%) surviving newborns. Among them, 55 (58.51%) were premature infants. 32 (42.11%) had mothers with mild to moderate PH, and 23 (62.16%) had mothers with severe PH. There was a significant statistical difference in the preterm birth rate of newborns between the two groups of patients. Among the surviving newborns, 53 (56.38%) had low birth weight, 33 (43.42%) were in the mild to moderate group, and 20 (54.05%) were in the severe group. There was a statistically significant difference in the low birth weight of newborns between the two groups, and patients with severe PH were more likely to have low birth weight of newborns. The weight of the newborns was significantly lower than that of the mild to moderate group. 21 (22.34%) of newborns had asphyxia, among which 8 (11.94%) were in the mild to moderate group and 13 (48.15%) were in the severe group. Compared with the mild to moderate group, newborns in the severe group were more prone to asphyxia, and the difference was statistically significant(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePH during pregnancy is a disease that can threaten the lives of pregnant and postpartum women and is caused by multiple factors. In this study, CHD-PAH and LHD-PH accounted for the highest proportions. PH during pregnancy is extremely rare, but the maternal mortality rate is very high, as are the rates of preterm birth and mortality of fetuses. PH is classified as mWHO Category 4 in the revised World Health Organization maternal (mWHO) cardiovascular risk classification [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, patients with PH are often prohibited from getting pregnant [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. With the advancement of medical technology, the application of targeted drugs and multidisciplinary interventional comprehensive diagnosis and treatment, studies have shown that the pregnancy outcomes of patients with mild PH during pregnancy have significantly improved under close monitoring and multidisciplinary comprehensive treatment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. PH during pregnancy is not an absolute contraindication [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].However, for patients with pregnancy complicated with severe PH, the mortality rate remains high. It is still recommended that patients with severe PH refrain from pregnancy. The principle of individualized diagnosis and treatment should be adopted for patients with pregnancy complicated with PH [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, in this study, mild PH and moderate PH were combined into one group and compared with severe PH to analyze the maternal and infant outcomes of patients with different degrees of PH during pregnancy. This study shows that the prognosis of patients with pregnancy complicated with different degrees of PH varies. Among the 113 patients, 2 died, with a mortality rate of 1.77%. Both of the 2 patients were severe PH patients, and the mortality rate of severe cases was 5.4%, which was much lower than that reported in the literature [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The possible reason is that our hospital, as the Guangdong Provincial Center for Critical Pregnant Women, has accumulated certain experience in the treatment of critical pregnant women. Among the two deceased patients, one was caused by IPAH and the other by congenital heart disease. Literature reports that IPAH is the most dangerous with an extremely high mortality rate [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As the PAP increased, the cardiac function classification of the patients became higher. The cardiac functions of the two deceased patients were both grade 3\u0026ndash;4, and both suffered from heart failure and MODS. Despite active rescue efforts, they eventually died. Previous studies have shown that grade 3\u0026ndash;4 cardiac function is an independent factor for adverse pregnancy outcomes in pregnancy complicated with PH [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our research shows that with the increase of PAP, the proportion of patients with PH during pregnancy whose cardiac function is at grade 3\u0026ndash;4 is relatively high.\u003c/p\u003e\u003cp\u003eDuring pregnancy and childbirth, a series of physiological changes occur in women, with increased blood volume and cardiac output, and a heavier burden on the heart. As the gestational weeks increase, the changes in maternal blood volume and hemodynamics become more obvious, and the cardiac load brought by pregnancy becomes more severe. Healthy women can adapt to this physiological change. However, in patients with pregnancy complicated with PH, the physiological changes brought about by pregnancy can further exacerbate PH, making them prone to cardiopulmonary complications and leading to disastrous consequences [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In our study, the gestational weeks of patients with different degrees of PH were different. There were significant statistical differences between patients with mild to moderate PH and those with severe PH. The gestational weeks of patients with severe PH were significantly shortened, indicating that as the PAP increased, patients were less adaptable to the physiological changes brought about by pregnancy and were more prone to complications. Compared with patients with mild to moderate PH, those with severe PH during pregnancy are more likely to have complications such as Eisenmenger syndrome, Pulmonary embolism, Heart failure, Pericardial effusion, Arrhythmia, Pulmonary edema, Pulmonary infection and MODS. Therefore, for pregnancy complicated with severe PH, it is usually recommended to avoid getting pregnant. For patients who are already pregnant, it is also recommended to terminate the pregnancy early. Once pregnancy is maintained, it is recommended to choose CS for delivery in the middle and late stages. CS can quickly end the pregnancy, avoid the increase in blood return to the heart caused by uterine contractions, and at the same time reduce the increase in cardiac load caused by uterine contraction pain. It is the preferred delivery method for pregnancy complicated with PH [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Among the patients in our study this time, only two chose natural delivery, while the rest all opted for CS. For patients undergoing CS, perioperative management is of vital importance. Preoperative multidisciplinary consultation, selection and management of anesthesia, and admission to the ICU for comprehensive monitoring and treatment can improve maternal and infant outcomes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our study, a total of 50 patients (44.25%) were transferred to the ICU, among which 17 (22.37%) were mild to moderate and 33 (89.19%) were severe. There were statistically significant differences in the transfer to the ICU and the duration of stay in the ICU between the two groups of patients. The severe group had more patients transferred to the ICU and a longer duration of stay in the ICU. Both general anesthesia and intraspinal anesthesia have been reported to be used in pregnancy complicated with PH, but there is no consensus on which anesthesia method to choose [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. General anesthesia, due to its definite anesthetic effect, significant analgesic, sedative and muscle relaxation effects, inhibits the excitation of the sympathetic nerve in patients, thereby reducing the occurrence of acute pulmonary edema, and at the same time can better provide oxygenation. Intraspinal anesthesia can cause the blood vessels in the blocked area of the sympathetic nerve of the patient to dilate, thereby reducing peripheral vascular resistance, decreasing return blood volume, making circulation more stable, and at the same time reducing the preload of the right heart of the patient, decreasing myocardial oxygen consumption, and lowering the risk of pulmonary infection caused by endotracheal intubation in the patient [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our current study, 43 patients (44.33%) who underwent CS chose general anesthesia, among which 22 (28.95%) were in the mild to moderate group and 21 (56.76%) were in the severe group. A total of 54 (55.67%) of patients received intraspinal anesthesia, including 47 (61.84%) in the mild to moderate group and 7 (18.92%) in the severe group. There was a significant statistical difference in the choice of anesthesia methods between the two groups of patients undergoing CS. Patients with mild to moderate conditions were more inclined to choose intraspinal anesthesia, while those with severe conditions had a higher proportion of choosing general anesthesia. General anesthesia can be safely used for CS in patients with pregnancy complicated with severe PH, especially when complications occur during the operation, it is more convenient to treat patients under general anesthesia. Hemodynamics is easier to control. Among our patients, there was one who developed pulmonary embolism during a CS. Through our efforts in rescue, the patient eventually recovered and was discharged from the hospital. We have previously reported this case [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFetuses of patients with PH during pregnancy are more prone to adverse outcomes, with a higher risk of premature birth, low birth weight of newborns, and fetal and neonatal death [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our current study, there were 10 (8.85%) of miscarriage, 7 (6.19%) of intrauterine fetal death, and 1 (1.05%) of neonatal death. The deceased newborns were born to patients in the severe group. There was no statistically significant difference in the miscarriage rate and stillbirth rate between the two groups of patients. However, with the increase of PAP, the proportion of miscarriage and stillbirth in pregnant women increased. Our research shows that the premature birth rate of newborns is 58.51%. The proportion of premature births among pregnant women with different degrees of PH varies. 42.11% of the fetuses in the mild to moderate group were premature, which is lower than 62.16% in the severe group. Among the surviving newborns, 56.38% had low birth weight and 22.34% had asphyxia. There were statistically significant differences in the rates of low birth weight and asphyxia between the two groups of patients. The fetal outcomes in the mild to moderate group were better than those in the mild group. In this study, the neonatal mortality rate was lower than that reported in the literature [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], indicating that proper perinatal management can significantly improve the pregnancy outcomes of patients with pregnancy complicated with PH.\u003c/p\u003e\n\u003ch3\u003eStudy limitations\u003c/h3\u003e\n\u003cp\u003eThis study has certain limitations. This is a single center retrospective study, and there may be some bias in the study population and results. In addition, the diagnostic criterion for PH is right cardiac catheterization. As the study subjects were pregnant women, echocardiography was used for diagnosis, and there may be some deviation in the results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, the mortality rate of patients with PH during pregnancy is extremely high and it is a contraindication for pregnancy. However, with proper perinatal management, early warning and termination of pregnancy when necessary, patients with mild to moderate PH can still be safe. For patients undergoing CS, those with mild to moderate conditions can choose intraspinal anesthesia, while for those with severe conditions, general anesthesia is more conducive to intraoperative management. If general anesthesia is properly managed, it can be safely used for CS in patients with pregnancy complicated with severe PH.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePH \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePulmonary hypertension\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIPAH \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIdiopathic pulmonary arterial hypertension\u003c/p\u003e\n\u003cp\u003eCHD-PAH \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePAH complicated with congenital heart disease\u003c/p\u003e\n\u003cp\u003eLHD-PAH \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePAH complicated with left heart disease\u003c/p\u003e\n\u003cp\u003eoPAH \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePAH combined with other diseases\u003c/p\u003e\n\u003cp\u003eHT-PAH \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePAH caused by hereditary telangiectasia\u003c/p\u003e\n\u003cp\u003esPAP \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePulmonary artery systolic pressure\u003c/p\u003e\n\u003cp\u003eNYHA \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNew York Heart Association\u003c/p\u003e\n\u003cp\u003eICU \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIntensive care unit\u003c/p\u003e\n\u003cp\u003eCS \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCesarean section\u003c/p\u003e\n\u003cp\u003eMPAP \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMean pulmonary artery pressure\u003c/p\u003e\n\u003cp\u003ePAP \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePulmonary artery pressure\u003c/p\u003e\n\u003cp\u003eHF \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHeart failure\u003c/p\u003e\n\u003cp\u003eMODS \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultiple organ dysfunction syndrome\u003c/p\u003e\n\u003cp\u003emWHO \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWorld Health Organization maternal\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJiehong Xie: Study Design, Methodology, Collect data,Statistical analysis, Supervision, Project administration,Manuscript Preparation \u0026amp; editing.Yafen Wu: Collect data,Statistical analysis.Shouping Wang:\u0026nbsp;Study Design, Methodology, Supervision, Project administration,Manuscript review and revision,\u0026nbsp;Funding acquisition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Key Health Research Project of Liwan District Science and Technology Plan (NO: 202201011); 2. Basic and Applied Basic Project of Guangdong Provincial Department of Science and Technology (NO: 2021A1515220002); 3. Clinical Characteristic Technology Construction Project of Guangzhou Health Commission in 2023 (NO: 2023C-TS55).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data supporting the results of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University. According to the ethical standards of the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University, this study applied for exemption from informed consent. All studies conducted in this study comply with the ethical standards of the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University and the 1964 Helsinki Declaration and its subsequent revisions or similar ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinicl trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMocumbi A, Humbert M, Saxena A et al. Pulmonary hypertension. Nat Rev Dis Primers. 2024;10(1):1. Erratum in: Nat Rev Dis Primers. 2024;10(1):5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLow TT, Guron N, Ducas R, et al. Pulmonary arterial hypertension in pregnancy-a systematic review of outcomes in the modern era. Pulm Circ. 2021;11(2):20458940211013671.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHemnes AR, Kiely DG, Cockrill BA, et al. Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute. Pulm Circ. 2015;5(3):435\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHumbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2023;61(1):2200879.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCorbach N, Berlier C, Lichtblau M, et al. Favorable Pregnancy Outcomes in Women With Well-Controlled Pulmonary Arterial Hypertension. Front Med (Lausanne). 2021;8:689764.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePiao C, Wang WJ, Deng Y, et al. Clinical outcomes of pulmonary hypertension in pregnancy among women with congenital heart disease in China. J Matern Fetal Neonatal Med. 2023;36(1):2183349.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartin SR, Edwards A. Pulmonary Hypertension and Pregnancy. Obstet Gynecol. 2019;134(5):974\u0026ndash;987.Erratum in: Obstet Gynecol. 2020;135(4):978.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHemnes AR, Kiely DG, Cockrill BA, et al. Statement on pregnancy in pulmonary hypertension from the pulmonaryvascular research institute. Pulm Circ. 2015;5(3):435\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRashidi F, Sate H. Pregnancy outcome in a pregnant patient with idiopathic Pulmonary Arterial Hypertension: a case report and review of the literature. J Med Case Rep. 2018;12(1):31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDai Q, Shang M, Zhou Y, et al. Evaluation of maternal-fetal outcomes in pregnancy complicated with severe pulmonary hypertension and its influencing factors: a single-center retrospective study in China. J Matern Fetal Neonatal Med. 2023;36(2):2290923.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePan J, Wu Q, Chen S, et al. Clinical outcomes of pregnancy in patients with pulmonary hypertension: A single center observational study. J Cardiothorac Surg. 2025;20(1):199.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTeng Y, Zong L, Ding J, et al. Management of pulmonary arterial hypertension: before, during and after pregnancy. Int J Cardiol Cardiovasc Risk Prev. 2024;21:200252.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShu T, Feng P, Liu X, et al. Multidisciplinary Team Managements and Clinical Outcomes in Patients With Pulmonary Arterial Hypertension During the Perinatal Period. Front Cardiovasc Med. 2021;8:795765. fcvm.2021.795765.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMing Y, Wu Z, Wu Z, et al. Effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension: a meta-analysis. Arch Gynecol Obstet. 2022;306(1):7\u0026ndash;15. Epub 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIdehen HO, Amadasun FE, Ekwere IT. Comparison of intravenous colloid and colloid-crystalloid combination in hypotension prophylaxis during spinal anesthesia for cesarean section. Niger J Clin Pract. 2014;17(3):309\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBehdad S, Hajiesmaeili MR, Abbasi HR, et al. Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial. Anesth Pain Med. 2013;3(2):230\u0026ndash;3. Epub 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen W, Liang P, Zhan H, et al. Pulmonary embolism during cesarean section in a patient with severe pulmonary hypertension. Int J Gynaecol Obstet. 2022;157(1):200\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Y, Li Y, Zhang J, et al. Pregnancy complications and outcomes among women with congenital heart disease in Beijing China. Front Cardiovasc Med. 2021;8:765004.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSliwa K, van Hagen IM, Budts W, et al. Pulmonary hypertension and pregnancy outcomes: data from the registry of pregnancy and cardiac disease (ROPAC) of the European Society of Cardiology. Eur J Heart Fail. 2016;18(9):1119\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePan J, Wu Q, Chen S, et al. Clinical outcomes of pregnancy in patients with pulmonary hypertension: A single center observational study. J Cardiothorac Surg. 2025;20(1):199.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pulmonary hypertension, Pregnancy, Pregnancy outcomes, Anesthesia","lastPublishedDoi":"10.21203/rs.3.rs-7775285/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7775285/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePregnancy complicated with pulmonary hypertension(PH) is rare but carries great risk. Our aim is to explore the clinical characteristics and anesthesia management experience of pregnant women with PH, and to improve pregnancy outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective analysis was conducted on the clinical data of 113 pregnant women with PH admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to February 2025\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eAmong 113 pregnant women with PH, 13 (11.50%) had idiopathic pulmonary arterial hypertension (IPAH), 32 (28.32%) had PAH complicated with congenital heart disease (CHD-PAH), and 44 (38.94%) had PAH complicated with left heart disease (LHD-PAH). There were 23 (20.35%) of PAH combined with other diseases (oPAH) and 1 (0.88%) of PAH caused by hereditary telangiectasia (HT-PAH). Pregnant women are classified into mild to moderate PH: pulmonary artery systolic pressure (sPAP) of 36-69mmHg (1mmHg\u0026thinsp;=\u0026thinsp;0.133kPa) and severe PH: sPAP\u0026thinsp;\u0026ge;\u0026thinsp;70mmHg. 76 (67.26%)in the mild to moderate group and 37(32.74%) in the severe group. Two patients died, with a severe mortality rate of 5.4%. Compared with the mild to moderate PH group, the severe PH group had shorter gestational age, a higher proportion of New York Heart Association (NYHA) heart function grade 3\u0026ndash;4 patients, a higher proportion of patients transferred to the intensive care unit (ICU), and longer hospital stays in the ICU. The incidence of perioperative cardiopulmonary complications is relatively high. 97 (85.84%) of patients chose cesarean section(CS), 43 (44.33%) chose general anesthesia, including 21 (56.76%) in the severe group. There were 10 cases (8.85%) of miscarriage and 7 (6.19%) of intrauterine fetal death. The preterm birth rate, low birth weight rate of newborns and neonatal asphyxia rate in the severe group were higher than those in the mild to moderate group. There was 1 (0.88%) of neonatal death in the severe group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThere are significant differences in pregnancy outcomes among pregnant women with varying degrees of PH. The pregnancy outcomes of patients with mild to moderate pulmonary hypertension are better. General anesthesia, when properly managed, can be safely used for cesarean section in patients with pregnancy complicated with severe pulmonary hypertension.\u003c/p\u003e","manuscriptTitle":"Pregnancy outcomes of 113 patients with pregnancy complicated with pulmonary hypertension","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 19:26:47","doi":"10.21203/rs.3.rs-7775285/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9f6848b5-4079-4358-9446-28dc57f971d5","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T07:56:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-04 19:26:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7775285","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7775285","identity":"rs-7775285","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}