Nan fang yi ke da xue xue bao = Journal of Southern Medical University · 2026
[Perioperative outcomes and anesthetic management of pregnancy termination in patients with pulmonary hypertension].
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Yang Liting, Zhong Feng, Zhang Jingyi, Ye Yingxian, Ji Wenjin, Shu Haihua, Liu Yanli, Liang Jiexian
Аннотация
OBJECTIVES: To investigate outcomes of pregnancy termination in women with pulmonary hypertension (PH) and the correlations of anesthetic management strategies and intraoperative blood pressure variability with postoperative adverse events.
METHODS: Sixty-two women underwent termination of pregnancy complicated by PH from June, 2019 to December, 2024 in Guangdong Provincial People's Hospital, including 24 women with mild-to-moderate PH and 38 with severe PH. Perioperative parameters and clinical outcomes of the patients were compared between the two groups.
RESULTS: The most common subtype of PH in these women was pulmonary arterial hypertension (82.3%), caused primarily by congenital heart diseases (most frequently atrial or ventricular septal defects). The majority of the women underwent pregnancy termination by dilation and curettage (P=0.02) under general anesthesia (P=0.002). A total of 5 postoperative adverse events were recorded, including PH crisis (3 cases), arrhythmia requiring intervention (1 case), and pulmonary embolism (1 case). After multivariate adjustment, the severity of PH was significantly correlated with both postoperative ICU admission and prolonged postoperative length of stay (P<0.05). Among the patients undergoing dilation and curettage, the incidence of postoperative adverse events was significantly higher in patients receiving intrathecal anesthesia (P=0.014). A high blood pressure variability during surgery was correlated with a high rate of postoperative adverse events (P<0.05), which was significantly lower in patients with a blood pressure variability below the third tertile (OR=10.25, 95% CI=1.06-98.84, P=0.034).
CONCLUSIONS: Postoperative recovery following pregnancy termination is associated with the severity of PH. Anesthetic methods for pregnancy termination should be individualized. Patients with a high intraoperative blood pressure variability have an increased risk of postoperative adverse events, and inhaled nitric oxide therapy is effective for reducing pulmonary arterial pressure during surgery.
METHODS: Sixty-two women underwent termination of pregnancy complicated by PH from June, 2019 to December, 2024 in Guangdong Provincial People's Hospital, including 24 women with mild-to-moderate PH and 38 with severe PH. Perioperative parameters and clinical outcomes of the patients were compared between the two groups.
RESULTS: The most common subtype of PH in these women was pulmonary arterial hypertension (82.3%), caused primarily by congenital heart diseases (most frequently atrial or ventricular septal defects). The majority of the women underwent pregnancy termination by dilation and curettage (P=0.02) under general anesthesia (P=0.002). A total of 5 postoperative adverse events were recorded, including PH crisis (3 cases), arrhythmia requiring intervention (1 case), and pulmonary embolism (1 case). After multivariate adjustment, the severity of PH was significantly correlated with both postoperative ICU admission and prolonged postoperative length of stay (P<0.05). Among the patients undergoing dilation and curettage, the incidence of postoperative adverse events was significantly higher in patients receiving intrathecal anesthesia (P=0.014). A high blood pressure variability during surgery was correlated with a high rate of postoperative adverse events (P<0.05), which was significantly lower in patients with a blood pressure variability below the third tertile (OR=10.25, 95% CI=1.06-98.84, P=0.034).
CONCLUSIONS: Postoperative recovery following pregnancy termination is associated with the severity of PH. Anesthetic methods for pregnancy termination should be individualized. Patients with a high intraoperative blood pressure variability have an increased risk of postoperative adverse events, and inhaled nitric oxide therapy is effective for reducing pulmonary arterial pressure during surgery.