Peripartum substitution of inhaled for intravenous prostacyclin in a patient with primary pulmonary hypertension.

WE report a parturient with severe primary pulmonary hypertension who was receiving chronic intravenous prostacyclin (epoprostenol, PGI 2 , Flolan®; GlaxoSmith-Kline, Research Triangle Park, NC) and changed to inhaled prostacyclin prepartum. Our strategy was to take advantage of the selective pulmonary artery (PA) vasodilation afforded by inhaled prostacyclin to minimize systemic side effects such as arterial hypotension and antiplatelet effects seen with intravenous administration. We theorized that this approach would allow for uninterrupted PA vasodilation while simultaneously minimizing the risk of antiplatelet effects and would thereby permit safer epidural catheter placement necessary for effective analgesia for planned forceps-assisted vaginal delivery.