Pulmonary Hypertension in Pregnancy — Orderset
FOR PHYSICIAN USE ONLY.
This condition requires MFM + Cardiology + ICU + Anesthesia + Neonatology co-management.
This condition requires MFM + Cardiology + ICU + Anesthesia + Neonatology co-management.
1) Admission & Monitoring
- ICU or Cardiac Step-down admission
- Continuous telemetry, SpO₂, strict I/O
- Arterial line if unstable
2) Initial Laboratory Orders
- CBC, CMP, Magnesium, BNP
- Troponin if decompensation suspected
- Type & Screen
3) Oxygenation & Ventilation
- O₂ to maintain SpO₂ ≥ 94%
- High-flow nasal cannula if worsening
- Avoid intubation unless life-saving
4) Pulmonary Vasodilator Therapy
- Sildenafil 20 mg PO TID
- Epoprostenol IV 2–10 ng/kg/min (titrate ICU)
- Inhaled Nitric Oxide (acute RV failure)
- Avoid endothelin receptor antagonists
Inhaled Nitric Oxide (iNO) Dosing Calculator
5) Anticoagulation
- Enoxaparin 1 mg/kg SQ q12h
- Transition to IV heparin near delivery
- Warfarin contraindicated
6) Delivery Planning
- Planned ICU delivery 34–36 weeks
- Assist vaginal delivery if stable
- Cesarean only if unstable
- Avoid spinal anesthesia in severe RV failure
7) Postpartum ICU Care
- Highest risk days 1–10 postpartum
- Continue ICU monitoring ≥ 5 days
- Resume full vasodilator therapy
8) Future Pregnancy & Contraception
- Future pregnancy contraindicated
- LARC strongly recommended
- Sterilization may be discussed
References
1. ESC Guidelines on cardiovascular disease in pregnancy — Eur Heart J. 2. AHA Scientific Statement: Pulmonary hypertension in pregnancy. 3. SMFM Consult Series: Cardiac disease in pregnancy. 4. ACC/AHA Pulmonary Hypertension Guidelines. 5. FDA Pregnancy & Lactation Labeling Rule.