Maternal and neonatal outcomes in pregnant women with pulmonary hypertension: A retrospective study from a Tunisian tertiary center (2013-2023).

BACKGROUND: Pulmonary hypertension during pregnancy remains a life-threatening condition associated with substantial maternal and neonatal risk. Most published data originate from high-income countries, whereas data from low- and middle-income settings remain limited. METHODS: We conducted a retrospective case series of 22 pregnant women with echocardiographically confirmed pulmonary hypertension who delivered between 2013 and 2023 at a Tunisian tertiary referral center. Clinical characteristics, anesthetic management, and maternal and neonatal outcomes were reviewed. Mean systolic pulmonary artery pressure was 62.2 ± 21.8 mmHg, with a maximum recorded value of 120 mmHg. RESULTS: Pulmonary hypertension was predominantly related to left heart disease. Two patients had severe pulmonary arterial hypertension with suprasystemic pulmonary pressures. Cesarean delivery was performed in 20 patients (90.9%). Neuraxial anesthesia was used in 19 patients (86.4%), predominantly using a combined spinal-epidural technique. Vasopressor support was not required in 45.5% of cases, whereas prophylactic ephedrine was administered in selected high-risk patients according to institutional practice. Maternal complications were infrequent and consisted mainly of transient hypotension and acute pulmonary edema. No maternal deaths occurred during hospitalization or within 30 days postpartum. Neonatal outcomes were generally favorable. CONCLUSIONS: Favorable maternal and neonatal outcomes were observed in this cohort managed within a specialized multidisciplinary setting. These findings primarily reflect pulmonary hypertension related to left heart disease and should not be extrapolated to severe pulmonary arterial hypertension. Larger studies are needed to better define optimal management strategies across different pulmonary hypertension subtypes.