Unplanned or unexpected pregnancies
What happens if you find yourself unexpectedly pregnant with pulmonary hypertension?
Unexpected pregnancies happen on a regular basis. A Government report in 2018 suggested up to one in three births are unplanned. Although some contraceptives have very low failure rates, none are 100% failsafe; we sometimes use them incorrectly, or forget to use them on occasions, or have misconceptions that we can’t get pregnant so don’t use them at all. So, it’s not surprising that women with pulmonary hypertension can find themselves unexpectedly pregnant.
If you find yourself in this situation, inform your medical team straight away. Don’t try adjusting your medication in any way, even if it says not to be taken when pregnant. It’s really important to keep your PH as stable as possible so keep on with your regular medication until you’ve talked through your options with your team.
For some women, pregnancy is the trigger leading to the diagnosis of pulmonary hypertension. As mentioned earlier, pregnancy puts pressure on the heart so if there is an undiagnosed problem before pregnancy, symptoms will start to develop as the heart has to work harder. This can lead to the challenging situation where a woman who had planned a pregnancy finds herself unexpectedly diagnosed with PH.
In both situations, the medical advice will always be the same – to terminate the pregnancy. The medical team will always prioritise a mother’s health over that of an unborn baby, so looking at the published survival rates for women with PH, the safest outcome for a woman would be not to progress with a pregnancy.
You are the one who has to live with the decision though, so you need to be sure you have made the right choice for you and your family. Your healthcare team know how difficult these decisions can be and they are there to advise you, answer your questions and support you in your decision making. It is really important you ask everything you need to before making your mind up. Sometimes it’s easier to write questions down as you think of them, and then raise them when you speak to a member of your team.
Termination of pregnancy
A pregnancy can be terminated in different ways and the method used is normally dependent on the gestation (how pregnant you are). Broadly speaking there are two ways- either surgical or medical.
Medical termination uses medication to trigger the pregnancy to end and then come away from the womb. Surgical termination involves a general anaesthetic and a surgical procedure to remove the pregnancy through the neck of the womb.
The management of terminations in women with PH does differ a little from that for women without any medical conditions. There are fewer options and all terminations, at any stage, are best done in a hospital setting. This is because there is a risk that the interventions may trigger a worsening of PH symptoms.
In women who have to terminate the pregnancy later, a medical method is used. This is carried out whilst the woman is on an intensive care unit so that she can be monitored regularly. Medication is given to cause the end the pregnancy and then cause it to come away, which in effect is causing the woman to go into labour and deliver the foetus.
This can be very difficult as often the foetus is well developed at this stage and it can be distressing to see. However, all the staff involved are aware of how difficult this whole experience is and will do their best to support the patient and her partner through it and make the whole process as smooth as possible.
Choosing to continue with the pregnancy
For some of you who find yourselves unexpectedly pregnant, your decision will be to continue with the pregnancy. Do not be surprised if your team questions your choice and continues to present the risks of continuing the pregnancy. This is because they are responsible for your medical care and based on the information available, this is an option which is incredibly risky to your health. It could also be that have experienced the worst-case scenario and have seen patients die and want to be sure you understand what you could be facing.
Nonetheless, the doctors and nurses are there as your advisers, your advocates and your guides, so, if after you have weighed the risks and benefits, your decision is to continue with the pregnancy, they will support you in that choice.