D28-01 Maternal Mortality and Postpartum Heart Failure in Patients With Pulmonary Hypertension Undergoing Vaginal Delivery Versus Cesarean Section: A Systematic Review and Meta-Analysis

Rationale

The profound hemodynamic shifts during labor, delivery, and the postpartum period pose significant risks of exacerbation or even death in patients with pulmonary hypertension. Therefore, pregnancy is strongly discouraged in patients with pulmonary hypertension. For those who opt for pregnancy, the optimal mode of delivery remains an unresolved clinical question. Cesarean section has been historically favored for perceived control, but vaginal delivery may avoid the additional fluid shifts and blood loss of major surgery. Currently, there is a lack of evidence on the superiority of Cesarean section to vaginal delivery regarding maternal outcomes. This study aims to compare the maternal mortality and postpartum heart failure associated with vaginal delivery and Cesarean section in patients with pulmonary hypertension.

Methods

Observational studies and clinical trials reporting the outcomes of vaginal delivery and Cesarean section in patients with pulmonary hypertension are searched. We conduct a systematic review and meta-analysis of observational studies and clinical trials comparing the outcomes of vaginal delivery to Cesarean section in patients with pulmonary hypertension. The primary outcome is maternal mortality within 6 months postpartum. The secondary outcome is the risk of postpartum heart failure. Pooled risk ratios with 95% confidence intervals are calculated using a random-effects model.

Results

A total of 7 observational studies were identified and included for analysis, comprising 9076 patients (n = 2952 for vaginal delivery and n = 6124 for Cesarean section). The mean maternal age is 30.61 years. Most maternal deaths occurred within the first week after delivery. Maternal mortality is 1.9% in patients undergoing vaginal delivery and 3.2% in those receiving Cesarean section; however, there is no statistically significant difference between vaginal delivery and Cesarean section in terms of maternal mortality (risk ratio 0.88, 95% confidence interval 0.41-1.92). In patients undergoing vaginal delivery, 6.0% developed postpartum heart failure, while 7.4% of those receiving Cesarean section had postpartum heart failure; similarly, we find no statistically significant difference in the risk of postpartum heart failure between vaginal delivery and Cesarean section (risk ratio 0.8, 95% confidence interval 0.38-1.72).

Conclusions

The risks of maternal mortality and postpartum heart failure are comparable between patients with pulmonary hypertension undergoing vaginal delivery and those undergoing Cesarean section. Vaginal delivery is a valid mode of delivery for patients with pulmonary hypertension, especially for patients in stable conditions or those with mild pulmonary hypertension. However, the data of this study comes from observational studies. Randomized controlled trials are warranted to confirm the conclusion.

This abstract is funded by: None