Table 2.

Strengths and weaknesses of delivery methods for patients with PAH undergoing childbirth.

Delivery Method	Strengths	Weaknesses
Vaginal Delivery	Non-surgical (reduce perioperative risk of intubation and minimize risk of post-operative complications) Option for modified valsalva pushing to avoid vasovagal response Risk of valsalva can be reduced by assisted second stage delivery (forceps lift-out or vacuum extraction)	Risk of poorly controlled pain (leading to vasovagal spiral with catecholamine release) Increased cardiac output with active labor, which can overwhelm RV Risk of hypotension or other medication effect if planned induction
Cesarean Delivery	Guideline recommended method in patients with PAH Controlled environment Avoid lengthy labor Option for regional anesthesia	Perioperative risks (e.g. fluid shifts) and risk of post-operative complications (e.g. risk of ileus) Risk of surgical site infections Risks associated with intubation if general anesthesia required