Copyright © 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. C URRENT O PINION Anesthesia for pregnant women with pulmonary hypertension Steffen Rex a,b and Sarah Devroe a Purpose of review Purpose of review is to summarize and highlight recent advances in the management of pregnant patients with pulmonary hypertension. Recent findings Despite recent advances in the therapy of pulmonary hypertension, prognosis for pregnant patients with pulmonary hypertension remains poor with high maternal mortality. Pregnancy is still considered contraindicated in these patients. If pregnancy occurs, referral to a tertiary hospital and a multidisciplinary approach ensure the best possible outcome. All pregnant patients with pulmonary hypertension should be counseled for a termination of pregnancy. If the patient wants to continue the pregnancy despite strong recommendations for therapeutic interruption, specific pulmonary hypertension therapy has to be initiated, adjusted, and/or augmented. A close clinical follow-up of the mother throughout the entire pregnancy is of utmost importance. Elective caesarean section in week 34–36 is recommended as preferred mode of delivery, preferentially under epidural or low-dose combined spinal-epidural anesthesia. Because of an acute increase in pulmonary vascular resistance and delivery-associated acute volume overload, the immediate postpartum period carries the highest risk for acute right ventricular failure necessitating close monitoring and treatment on an ICU. Summary Anesthesiologists involved in the management of pregnant patients with pulmonary hypertension must have detailed knowledge of pathophysiological alterations in pregnancy and during birth, cardiac (patho)physiology, cardiovascular and obstetric pharmacology, hemodynamic monitoring, and echocardiography. Both regional and general anesthesia have typical adverse effects that can severely jeopardize the cardiovascular system in patients with pulmonary hypertension, and should therefore be anticipated/prevented/rapidly treated by the attending anesthesiologist. Keywords anesthesia, pregnancy, pulmonary hypertension, pulmonary vascular resistance, right ventricle INTRODUCTION Pregnancy represents an enormous cardiovascular challenge for patients with pulmonary hypertension. Despite recent advances in the therapy of pulmonary hypertension, the prognosis for pregnant patients with pulmonary hypertension remains dismal with high maternal mortality rates. Therefore, pregnancy is contra-indicated in these patients. Should preg- nancy occur, patients should be offered abortion. If the patients choose to continue pregnancy, they should be followed in a tertiary referral center. Only a multidisciplinary team approach [involving obstet- ric (and cardiac) anesthesiologists, high-risk obstetri- cians, neonatologists, cardiologists, and specialists in the treatment of pulmonary hypertension], standard- ization of the peripartal management, close and continuous communication between all specialties involved, and the anticipation/recognition/prompt treatment of complications will be able to improve clinical outcomes. DEFINITION AND CLASSIFICATION Pulmonary hypertension is defined by a mean pul- monary arterial pressure (mPAP) of at least 25 mmHg a Department of Anesthesiology, University Hospitals Leuven and b Department of Cardiovascular Sciences, KU Leuven, Belgium Correspondence to Steffen Rex, MD, PhD, Department of Anesthesiol- ogy, University Hospitals Leuven, Herestraat 49, B – 3000 Leuven, Belgium. Tel: +32 16 34 42 70; fax: +32 16 34 42 45; e-mail: steffen.rex@uzleuven.be Curr Opin Anesthesiol 2016, 29:000–000 DOI:10.1097/ACO.0000000000000310 0952-7907 Copyright ß 2016 Wolters Kluwer Health, Inc. All rights reserved. www.co-anesthesiology.com REVIEW