General Obstetrics and Gynecology Obstetrics
An appraisal of treatment guidelines for antepartum community-acquired pneumonia☆

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Abstract

Objective: The optimal strategy for the initial evaluation and management, including criteria for hospitalization, of pregnant women with pneumonia has not been defined. Our purpose was to evaluate a treatment protocol for antepartum pneumonia and to identify criteria for selection of women for potential outpatient treatment. Study Design: A protocol based on British and American Thoracic Society guidelines was introduced and included prompt hospitalization and empiric initiation of erythromycin therapy. Maternal and neonatal outcomes were analyzed to assess the efficacy of the protocol. A second analysis involved the retrospective application of published guidelines to ascertain for which women outpatient management might have been appropriate. Results: There were no maternal deaths among the 133 women studied, and in 14 (10%) women there was a misdiagnosis at admission. Erythromycin monotherapy was judged adequate in all but one of the 99 women so treated. Using a modified version of the American Thoracic Society guidelines, we project that only 25% of the women hospitalized with pneumonia could have been managed safely as outpatients. Conclusion: Most pregnant women with pneumonia respond well to monotherapy with erythromycin. Outpatient management may be a reasonable option for selected women. (Am J Obstet Gynecol 2000;183:131-5)

Section snippets

Methods

Beginning January 1, 1993, as our observational study6 of pneumonia complicating pregnancy was concluding, we introduced a protocol to standardize the management of these women. The guidelines were approved by the institutional review board of the University of Texas Southwestern Medical Center and Parkland Memorial Hospital. As before,6 the diagnosis of pneumonia required typical clinical findings, the absence of another source of infection, and a chest radiograph of a lung infiltrate, as

Results

In the 5-year period from January 1993 to December 1997, 133 pregnant women were hospitalized with community-acquired pneumonia. A total of 112 (84%) of these women were delivered at our hospital by July 1998. During this same time, 74,392 women were delivered of their infants at Parkland Hospital; thus the incidence of community-acquired pneumonia was approximately 1.5 per 1000 deliveries.

The demographic characteristics of the women hospitalized with pneumonia were compared with those of the

Comment

Although there were no maternal deaths in this study, pneumonia remains a potentially fatal infection in these otherwise healthy young women.1 Specifically, 2% of these 133 women required tracheal intubation and mechanical ventilation. There was 1 fetal death associated with maternal sepsis, and preterm and low-birth-weight deliveries were almost twice as common in women with pneumonia compared with the general obstetric population.

There are 3 important observations that can be made from these

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☆

Reprint requests: Nicole P. Yost, MD, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9032.

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