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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