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Table 1 Bullet points for peripartum management of acute decompensation of previously undiagnosed pulmonary hypertension

From: Management of acutely decompensated chronic thromboembolic pulmonary hypertension in late pregnancy: a case report

1.

Establish invasive hemodynamic monitoring

• arterial, central line

• consider pulmonary arterial catheter

• consider PiCCO

2.

Provide respiratory support (aim for normoxia)

• high flow O2

• consider noninvasive ventilation

• avoid invasive ventilation if possible

3.

Provide hemodynamic support (aim for normal cardiac output)

• inotropic treatment: dobutamine, levosimendan

• vasodilator treatment: intravenous prostacyclin

• fluid management

4.

Assess ideal timing and mode of delivery

• urgent/emergent Cesarean based on maternal and fetal assessment

5.

Choose ideal anesthetic technique

• regional anesthesia if possible

6.

Continue postoperative monitoring

• observe for increasing hemodynamic instability

• observe for postpartum bleeding

7.

Assess ideal anticoagulation timing and agent

• heparin vs. LMWH