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Use of inhaled nitric oxide for emergency Cesarean section in a woman with unexpected primary pulmonary hypertension

[L'inhalation d'oxyde nitrique pour la césarienne d'urgence associée à une hypertension pulmonaire primitive inattendue]

Christopher Decoene, MD^*, Karim Bourzoufi, MD, Didier Moreau, MD^*, Fabrice Narducci, MD, Francis Crepin, MD^* and Renee Krivosic-Horber, MD

^* From the Clinic of Anesthesiology Reanimation in cardiovascular Diseases, the
Department Of Anesthesiology and Reanimation I and the
Jeanne de Flandres Obstetrical Clinic Lille, France.

Address correspondence: Dr. Christopher Decoene, Cardiologic hospital, CHRU Lille, 59037 Lille, France. Phone: 33320445352; Fax: 33320444810; E-mail: c-decoene{at}chru-lille.fr

Purpose: Use of inhaled nitric oxide (iNO) could be of importance in emergency cases of primary pulmonary hypertension (PPH) in pregnant patients during labour and delivery. iNO acts as a selective pulmonary bed vasodilator avoiding systemic hemodynamic effects due to its ease of administration. Pulmonary bed vasodilation improves right ventricular function directly and left ventricular function indirectly.

Clinical features: We report the case of a pregnant patient with unexpected PPH in whom an emergency Cesarean section (CS) had to be performed. PPH was diagnosed on admission as she arrived in active labour at 34 weeks gestational age. An emergency CS was performed under epidural anesthesia for breech presentation . All along labour, delivery and the first 24 hr, iNO was administered via a noninvasive ventilation device. CS was uneventful. A severe pulmonary hypertensive crisis was observed 12 hr after delivery and resolved with an increase of iNO concentration and administration of isoprenalin. The patient and baby returned home on day ten.

Conclusion: The ease of administration of iNO allowed the optimal control of pulmonary arterial hypertension. No interaction with epidural anesthesia was observed. Use of iNO can improve the management of urgent CS in women with unexpected PPH.

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