Elsevier

Critical Care Clinics

Volume 20, Issue 4, October 2004, Pages 731-745
Critical Care Clinics

Acute asthma in pregnancy

https://doi.org/10.1016/j.ccc.2004.05.013Get rights and content

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Maternal and fetal physiologic considerations during pregnancy

Respiratory and cardiovascular changes that occur during pregnancy have been well documented. Minute ventilation is increased by 50% in late pregnancy secondary to progesterone effect. This hyperventilation usually results from the increased tidal volume with minimal changes in respiratory rate. Arterial blood gases often reveal a compensated respiratory alkalosis (pH, 7.40–7.45; Pco2, 28–32 mm Hg) and a mild increase in Po2 (106–110 mm Hg). The increase in pH secondary to respiratory alkalosis

Effect of asthma on pregnancy

Studies on the effects of asthma on maternal and fetal outcomes are nonconclusive. Some studies found no significant difference in birth outcomes among asthmatic and nonasthmatic women [5], [9]. Other studies demonstrated that asthmatic mothers had more adverse outcomes, including intrauterine growth retardation [2], [10], [11], [12], preterm labor and delivery [2], [11], [12], [13], [14], and preeclampsia [11], [12], [15]. Other adverse outcomes included increased incidence of transient

Asthma management during pregnancy

The principles of asthma management for pregnant women are not different from those for nonpregnant women [33]. The goals of asthma management during pregnancy include the optimal control of asthma symptoms, attainment of normal pulmonary function, prevention and reversal of asthma exacerbation, and prevention of maternal and fetal complications. The four key components of management needed to achieve these goals are the following:

  • 1.

    Objective assessment and monitoring of maternal lung function

Efficacy and safety of asthma medications during pregnancy

There is limited information on the long-term efficacy and safety of currently approved asthma medications in pregnant women, largely because traditional, double-blind, placebo-controlled research is unethical in pregnant women. Most such information comes from retrospective case studies and anecdotal and epidemiologic reports that do not control for variables and isolate a particular drug's effect on a developing fetus. The main challenge in management is to reinforce the critical need for

Management of acute asthma during pregnancy

Approximately 18% of pregnant asthmatics have at least one ED visit, and as many as 62% of pregnant women with acute severe asthma require hospitalization [39]. As previously mentioned, poorly controlled severe asthma may result in a variety of maternal and fetal complications, including increased risks for preeclampsia, intrauterine growth retardation, preterm infants, and perinatal mortality [59]. When optimally managed with appropriate medications and monitoring, pregnant asthmatics manifest

Life-threatening asthma during pregnancy

Hospitalized patients with acute asthma must be evaluated carefully and appropriately transferred to the ICU, especially at the onset of maternal fatigue or with evidence of fetal distress or respiratory failure as evidenced by worsening Pco2. As mentioned earlier, acute asthma can result in dangerously low fetal oxygenation, and the basic management of acute life-threatening asthma exacerbation during pregnancy has the immediate goals of preventing and correcting hypoxemia (Pao2<60) with

Management of asthma during labor and delivery

Acute asthma exacerbations during labor and delivery are uncommon. They can cause substantial maternal and fetal distress. Asthma guidelines recommend that all regularly scheduled asthma medications be continued during labor and delivery [33]. Patients experiencing an acute asthma exacerbation should be treated promptly as outlined earlier. Intensive fetal and maternal monitoring is recommended. In patients who were treated with systemic corticosteroids 4 week before the onset of labor, stress

Obstetric management of pregnant patients with asthma

Lumbar epidural analgesia reduces oxygen consumption and minute ventilation and is considered an excellent choice during labor. Because morphine and meperidine may cause histamine release, their use should be avoided. The use of fentanyl as a narcotic analgesic is preferred.

If preterm labor occurs during pregnancy, tocolytic therapy may be considered. Because most patients with asthma are already receiving inhaled β2-agonists, administration of systemic β2-agonists as tocolytic agents may cause

Summary

Asthma commonly occurs in pregnant women. Although most women who have asthma during pregnancy have controlled disease, some women may experience exacerbation of their disease, necessitating immediate intervention. Treating physicians must overcome the common belief that pregnant women should not take any medications during pregnancy, and they should keep asthma in pregnant women under control so to minimize the risk for maternal and fetal hypoxia. Almost all medications used by nonpregnant

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