Hi Ahmed, Pulmonary Hypertension is a major problem for pregnant women with a high risk of morbididty and mortality. In some countries termination of pregnancy is a common approach for these cases. but this is not approved all over the world. The method of delivery is not the crucial decision here. proper assessment of PH is much more important ( cause, severity,associated cardiac or other system morbidity), then next step is management and control of PH according to assessment ( e.g Niric oxide). So I think, multidisciplinary approach is the best way to manage such a patient ( cardiology, anesthesia , ICU and OB & GYN).

off course delivery should be under anesthesia (proper anesthesia), type of anesthesia delivered is depending on her general condition, severity and cause of PH.

then general rules, avoid hypoxia, Hypercabia, acidosis, stress (sympathetic overstimulation).

check these 1-(Pulmonary arterial hypertension in the setting of pregnancy: a case series and standard treatment approach))Smith JS, Mueller J, Daniels CJ.

Lung. 2012 Apr;190(2):155-60. doi: 10.1007/s00408-011-9345-9. Epub 2011 Dec 3.

2-http://www.ncbi.nlm.nih.gov/pubmed/22588348Rimaitis K, Aliuškevičienė A, Adukauskienė D, Rimaitis M, Macas A.

I hope these 2 case reports might be helpful.

I agree with Mohamed that a multidisciplinary approach is the best way to manage a patient with pulmonary hypertension. In Uppsala University Hospital our "Heart-Mother Group" (obstetrician, cardiologist, obst.anesthesiologist , thorax anaesth. and cardiology nurse) follow recommendation of ESC Guidelines on the management of cardiovascular diseases during pregnancy. We usually performe a risk assessment according to WHO classification, and in cases with WHO risk IV, that majority of patients with pulmonary hypertension are, we offer a pregnancy termination. If patient choose to continue pregnancy despite the risk, we make a detailed management plan in order to minimize mortality and morbidity risks. Risk factors for maternal Death are: late hospitalization, severity of pulmonary hypertension and general anesthesia (Bedard et al , Eur Heart J 2009;30:256-265) and maternal death occurs most often in the last trimester of pregnancy and in the first months after delivery.

Opinions of experts mentioned above are very valuable. I just wish to mention a point that most maternal complications occures post partum but with in 48 Hrs. This is the time when major fluid shift occurs. So even if a parturition was uneventful, recovery can be complicated  if left unattended. One has to be more vegelant during this time.