Asthma complication in pregnancy

Asthma & pregnancy

A case presentation:

Status asthmatic complicated by emphysema and pneumomediastinum during  pregnancy

 A  25 y old 30 week pregnant,p3+2, known asthmatic on steroids, she stopped her medication during pregnancy thinking that its harmful to the baby,developed sever attack due to acute exacerbation after exposure to allergen , intubated .Then, she developed emphysema &pneumomediastinum ,she had  emergency caserean section ,the baby Apgar scor was very poor and unfortunately died after few days due to  fetal hypoxia.

Sever & poorly controlled asthma has been associated with numerous adverse perinatal outcome including preeclampsia , pregnancy induce hypertension ,uterine haemorrhage, pretermlabour, congenital abnormalities, fetal growth restriction & low birth weight.

Review of pathophysiology of asthma & the effect of the physiological changes of pregnancy on asthma.

The clinical assessment of asthma include both subjective evaluation & pulmonary function test & how to do that properly?        

Goals of management:

  Is to reduce hospitalization , emergency room admission, prevent work loss& chronic disability.

The key of treatment is by frequent assessment of the patients, the severity of the attack and the patient response to treatment. Both number & dosage of medications can be increased as asthma severity increased.

 Hypoxia, acidosis, hypercapniea & pneumothorax is a warning sign of sever exacerbations 

 The medication:

     B2 agonist is the mainstay of treatment; budesonide is the preferred inhaled steroid.

     Early systemic steroid,,theophylline, antihistamin oxygen supply, Intravenous fluid, avoids tranquilizer& sedative.

  

   Discussing the criteria for hospital admission & ICU admission &ventilation setting.

The prognosis;   great risk in the last portion of pregnancy.

Patient education:

   It is important because of most complication were due to under medication,

   Prevention & avoidance of triggers, allergens & irritant

   Home use of metered dose inhalers& pulmonary function test, using written diary to record PEFR

    Use a written guideline for management of exacerbation.