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Asthma in pregnancy
- 2. INTRODUCTION • Asthma is a chronic inflammatory airway syndrome. • Seen frequently in young women and therefore often complicates pregnancy. • The estimated asthma prevalence during pregnancy ranges between 4 and 8 percent, and this appears to be increasing
- 3. Physiological alterations in pregnancy • Vital capacity and inspiratory capacity ↑ • Tidal volume, Minute ventilation ↑ • Residual volume, Chest wall compliance, Expiratory reserve volume, functional residual capacity↓ • The end result of these pregnancy-induced changes is substantively increased ventilation due to deeper breathing
- 4. Pathophysiology • The hallmarks of asthma are – reversible airway obstruction from bronchial smooth muscle contraction – vascular congestion, – tenacious mucus, and mucosal edema • IgE also plays a central role in pathophysiology
- 5. Clinical course Hypoxia initially is well augmented by hyperventilation, which maintains arterial Po2 -results in respiratory alkalosis Airway narrowing worsens, ventilation perfusion defects increase -arterial hypoxemia sets in CO2 retention -respiratory failure follows
- 6. Effect of pregnancy on asthma • The symptoms may worsen, improve or remain stable during pregnancy. • Risk is higher following caesarean versus vaginal delivery. • Exacerbations are associated with respiratory infections and poor compliance with inhaled steroids.
- 7. Effect of asthma on pregnancy • Unless disease is severe, pregnancy outcomes are generally good. • Incidence of abortion is slightly increased • Higher risk of preeclampsia, preterm labour, IUGR, perinatal mortality. Good control reduces this risk. • Life threatening complications of severe asthma include respiratory arrest, pneumothorax, pneumo-mediastinum, acute cor-pulmonale and cardiac arrhythmias.
- 8. Clinical features • Symptoms are similar as nonpregnant and include cough, dyspnea and wheezing on auscultation. • Varied manifestations of asthma have led to a simple classification that considers severity as well as onset and duration • of symptom
- 10. Clinical evaluation • Pulmonary function testing should be routine in the management of chronic and acute asthma. • FEV1 and PEFR are the best measures of severity. • ABG is required in acute severe attack.
- 11. Management of chronic asthma • Patient education • Avoiding environmental precipitating factors • Objective assessment of PFTs • Monitoring of PFTs • Pharmacological therapy with compliance • Treatment depends on disease severity. • Beta agonists and inhaled steroids are safe in pregnancy.
- 13. Management of acute asthma • Hospitalization • Oxygen by mask • Pulse oximetry • Beta adrenergic agonists- oral/SC/inhaled • Corticosteroids- oral/IV- IV methylpredsinolone 40-60mg every 6 hours or equipotent doses of hydrocortisone • Further management depends on response to therapy with close observation and FEV1,PEFR.
- 14. Status asthmaticus • Severe asthma of any type not responding after 30-60 minutes of intensive therapy is termed status asthmaticus. • Rx- admission to ICU – Beta agonists – IV corticosteroids – Intubation and mechanical ventilation.
- 15. Intrapartum management • Asthma may worsen through delivery. • Stress dose corticosteroids are administered to any woman given systemic corticosteroid therapy within the preceding 4 weeks. Usual dose is 100mg of hydrocortisone given intravenously every 8 hours during labour and for 24 hours after delivery.
- 16. • Oxytocin and prostaglandins E1 and E2 may used • Prostaglandin F2α or ergotamine derivatives are contraindicated. • Regional analgesia is preferred because tracheal intubation can trigger severe bronchospasm. • Fentanyl is preferred to morphine.
- 17. Postpartum and breastfeeding • Continue the same asthma medications • Close peak flow monitoring • Compliance reinforced • Breastfeeding encouraged
- 18. THANK YOU..