Pregnant women with pulmonary hypertension (PH) have better postpartum outcomes with vaginal delivery, according to a new study reported by Anesthesiology News.

Researchers from Columbia University analyzed EMR data for all pregnancies with PH at Columbia University Medical Center from 1997 to 2013. They identified 20 cases (eight vaginal deliveries, nine cesarean deliveries and three terminated pregnancies).

The one-year mortality rate in the cohort was 25% compared with 20% reported in the medical literature. Three women who had a cesarean delivery died within 90 days of delivery and one patient died within 30 days after a terminated pregnancy. There were no deaths in the vaginal delivery group in the first year—one patient from this group died more than two years after delivery. The researchers also found that the congenital heart disease group used more advanced therapies for PHT such as extracorporeal membrane oxygenation.

“If you can get the women to deliver vaginally, and that does take some effort … those women do better. Most of the deaths were in women who had cesarean sections,” said Richard M. Smiley, MD, PhD, study author and chief of obstetric anesthesiology at NewYork-Presbyterian/Columbia University Medical Center, in New York City. “It does appear that the postoperative period after a cesarean is significantly more risky than the postpartum period after vaginal delivery.”