MHH is a centre for high-risk pregnancies with pulmonary hypertension
Little Amelie Maria lies in her mother’s arms and looks curiously into the world with wide eyes. She is only a few days old. Mother Maria L. (34) is overjoyed: her baby is healthy and she herself is doing well. This is not to be taken for granted, because Maria L. suffers from pulmonary hypertension. Only 20 years ago, a large number of mothers and children did not survive pregnancy or birth because of this disease. Even today, women with pulmonary hypertension are advised not to get pregnant - but in some cases, a baby is still on the way. This is a high-risk pregnancy. In the Department of Pneumology at the Hannover Medical School (MHH), these patients are accompanied through the birth. This is possible thanks to the long-standing cooperation of a multidisciplinary team and the development of care standards.
Very high risks during pregnancy
Pulmonary hypertension is a rare disease. It is called pulmonary arterial hypertension (PAH) in technical jargon. It is an increased blood pressure in the pulmonary circulation that leads to shortness of breath and reduced physical performance. If left untreated, the chronic disease can progress quickly and become life-threatening. "However, if the patients are well controlled and stabilised with medication, they can live with it for a long time," says Professor Dr Karen Olsson, senior physician in the Department of Pneumology. "Many of the affected women lead an almost normal life and of course also have a desire to have children." However, pregnancy and childbirth are hardly compatible with the severe chronic disease. The strain on the entire organism is very great and the risk of death - for example, from heart failure during or after birth - is high. Some women, however, become pregnant despite these dangers: either unintentionally or because their desire to have a child is so strong that they consciously take the risks.
Success is based on cooperation between many disciplines
"The issue of pregnancy in chronically ill women is really important. That’s why we have to offer these women the best possible counselling and care, even if the desire to have a child is not always feasible," explains Professor Olsson. The senior physician has been working on this issue for 15 years. It started with a scientific data collection, but over the years it has become much more. In the meantime, there are fixed standards of care for patients from pregnancy to birth to aftercare. The MHH is regarded throughout Europe as a centre for high-risk pregnancies with pulmonary hypertension. "This success is based on the fact that many different disciplines such as pneumology, prenatal diagnostics, obstetrics, neonatology, anaesthesia, intensive care medicine as well as cardiac, thoracic, transplantation and vascular surgery work very closely together," explains Professor Olsson. "We are a highly professional, extremely well-coordinated team." For example, up to 20 experts from different disciplines are involved in a birth. The technical effort to monitor the mother and the child is also enormous. In case of an emergency, for example, a so-called ECMO is kept ready for possible cardiovascular support outside the body.
The birth is by caesarean section in the 36th to 38th week of pregnancy and is meticulously discussed and planned by the entire team before the operation. However, the care of the expectant mother begins months beforehand. For the birth, the mother’s health condition must be absolutely stable, and she is closely monitored beforehand. This was the case with Maria L. The 34-year-old from Halle/Saale was diagnosed with pulmonary hypertension in 2020. In the following year, she was expecting a child. In September 2021, she was examined at the MHH for the first time. Since her medication had to be changed due to the pregnancy, her situation deteriorated in the meantime. From then on, a medication pump ensured the optimal administration of active substances via the vein. In this way, the mother-to-be’s condition stabilised again.
"I felt very well looked after here right from the start," says Maria L. about the care she received at the MHH. On 9 February, the time had come. "At 8 a.m. I was picked up to prepare for the caesarean section, at 12.30 p.m. we went to the operating theatre and at 1.41 p.m. Amelie Maria was there," Maria L. is pleased to say. After six days in the intensive care unit and one day in the normal ward, she was allowed to go home, where the newborn was welcomed by two big brothers and by her grandparents.
Further treatment standards planned
So far, the team has been able to help more than 25 children into the world this way - all of them were healthy and the mothers also recovered from the extreme situation. But there is no guarantee of that. "The risks are simply there, and we explicitly point this out to every woman," explains Professor Olsson. "In three of our patients, the circulation deteriorated so seriously after delivery that the use of ECMO became necessary and the patients then needed a lung transplant." It is still the case that not every woman with pulmonary hypertension can be granted the wish to have a child.
The pulmonologist is still in contact with many of the patients years later. Sometimes a postcard arrives for Christmas, sometimes a text message with a recent photo of the offspring. "That makes me very happy every time and confirms to me that our great efforts are right," says Professor Olsson. With the help of her colleagues, she would also like to develop treatment standards for other chronic lung diseases in order to be able to better care for women with lung diseases who are pregnant or wish to have a child.