The preoperative risks of pulmonary hypertension crisis for the cesarean puerpera with pulmonary artery hypertension

The parturient with pulmonary artery hypertension (PAH) often suffer with pulmonary hypertension crisis (PHC) and had high mortality rate during the cesarean section is often used to terminate pregnancy. This study aimed at exploring the preoperative risk factors of PHC in pregnant women with PAH during the cesarean section. 91 pregnant women with PAH were recruited from June 2013 to January 2022 and divided into PHC group (n = 18) and non-PHC group (n = 73) according to whether PHC occurred during the perioperative period. The general and clinical data were collected and compared within two groups. The diagnostic values were analyzed by receiver operating curve (ROC). The entry method and forward logistic regression (LR) method were to demonstrate the preoperative risk factors that may influence the occurrence PHC in pregnant women with PAH during the perioperative period. There were significant differences on the percentage of emergency surgery, the percentage of Eisenmenger syndrome, the placement of floating catheter, New York Heart Association (NYHA) classification, preoperative left ventricular end diastolic diameter (LVEDD), pulmonary artery systolic pressure (sPAP), the percentage of oral sildenafil and preoperative SpO2 between PHC group and non-PHC group (p < 0.05). The optimal cut-off values of NYHA classification, blood oxygen saturation (SpO2), preoperative LVEDD, preoperative sPAP were grade 3, 0.86, 45.58%, 132.87 mmhg separately via ROC curve analysis. The placement of a floating catheter, reduced LVEDD, and the orally unused administration of sildenafil could act as independent preoperative risk factors for PHC in pregnant women with PAH during cesarean section. Early high-risk groups can help prevent the occurrence of PHC in the perioperative management of PAH patients. These findings refine preoperative peri-cesarean risk stratification in PAH by emphasizing clinically actionable thresholds for NYHA class, SpO₂, LVEDD, and sPAP.