Managing asthma in expectant mothers Powrie, Raymond O; Larson, Lucia; Miller, Margaret
Treatments in respiratory medicine,
2006, Letnik:
5, Številka:
1
Journal Article
Recenzirano
Pregnancy does not appear to have a consistent effect on the frequency or severity of asthma. The most common cause of worsening asthma in pregnancy is likely to be noncompliance with medication. ...Emphasizing to the patient in advance that fetal well-being is dependent on maternal well-being may help prevent this.In general, well controlled asthma is not associated with a higher risk of adverse pregnancy outcomes. Essential to successful asthma management is patient education that helps to ensure effective medication use, avoidance of triggers, and prompt treatment. This education should include measurement of peak expiratory flow rate and a written asthma action plan. Most of the medications that are used to control asthma in the general population can be safely used in pregnant women. Inhaled beta-adrenoceptor agonists (beta-agonists), cromolyn sodium (sodium cromoglycate), and inhaled and systemic corticosteroids all appear to be very well tolerated by the fetus. Budesonide and beclomethasone should be considered as the preferred inhaled corticosteroids for the treatment of asthma in pregnancy. Use of the leukotriene receptor antagonists zafirlukast and montelukast in pregnancy is probably safe but should be limited to special circumstances, where they are viewed essential for asthma control. Zileuton should not be used in pregnancy.Acute asthma exacerbations in pregnant women should be treated in a similar manner to that in non-pregnant patients. Maternal blood glucose levels should be monitored periodically in pregnant women receiving systemic corticosteroids because of the deleterious effects of hyperglycemia upon embryos and fetuses. During pregnancy, maternal arterial oxygen saturations should be kept above 95% if possible for fetal well-being. Ambulatory oxygenation should be checked prior to discharge to ensure that women do not desaturate with their daily activities.Acute exacerbations of asthma during labor and delivery are rare. Dinoprost, ergometrine, and other ergot derivatives can cause severe bronchospasm, especially when used in combination with general anesthesia, and should be avoided in asthmatic patients. Pregnant women who have been treated with corticosteroids in the past year may require stress-dose corticosteroids during labor and delivery. Most asthma medications, including oral prednisone, are considered compatible with breast-feeding.
Abstract Objectives This study audited pregnancies where the mother received tinzaparin (at any stage before delivery), with a primary objective of determining the maternal safety of this low ...molecular weight heparin when administered as treatment and/or prophylaxis; the secondary objective was to audit fetal and neonatal safety in this cohort. Efficacy outcomes were also recorded. Study design The audit period was 1996–2009; consecutive, retrospective pregnancy records at participating hospitals were reviewed. For those records documenting tinzaparin use and pregnancy outcome, information was extracted into a standardised case report form; these were reviewed for adverse events, which were submitted for adjudication by independent experts in obstetric medicine and haematology. Endpoints were presented using descriptive statistics for all pregnancies, and by reason for tinzaparin use (treatment of venous thromboembolism VTE and prophylaxis). Results There were 28 participating hospital centres in eight countries (Belgium, Canada, Denmark, Ireland, Netherlands, Sweden, Spain and the UK). Data were collected from 1267 pregnancies (1120 women; 1303 fetuses); in 254 pregnancies the women received tinzaparin as treatment (median dose 13,000 international units IU/day, range 3500–23,100 IU/day; median duration 72 days; 94.1% once-daily), and in 1013 pregnancies the women received tinzaparin for prophylaxis (median dose 4500 IU/day, range 2500–21,811 IU/day, median duration 183 days, 94.6% once-daily). There were 871 (70.2%) vaginal deliveries (78 assisted) and 369 (29.8%) caesarean sections (27 delivery data missing). Overall, 495 (39.3%) women had neuraxial anaesthesia; however, there were no reported associated haematomas. There were no maternal deaths. Of pregnancies with available data (1060), 86.9% had blood loss ≤500 mL, 11.0% of >500 to ≤1000 mL, 0.9% >1000 to ≤1500 mL and 1.1% >1500 mL. There were 1245 (95.5%) live births, 15 (1.2%) stillbirths, 40 (3.1%) miscarriages and 3 (0.2%) terminations. Six (0.5%) neonatal deaths occurred (five at <27 weeks, one Ebstein's anomaly). No neonatal haemorrhages occurred. Adjudicated safety outcomes included 125 (9.9%) ‘any bleeding’ cases considered related to tinzaparin; 16 (1.3%) of these required medical intervention. In the treatment group, five (2%) recurrent VTEs were reported and 10 (1%) occurred in the prophylaxis group. Conclusions These data provide reassuring maternal and fetal outcome information in pregnancies exposed to tinzaparin.
Objective:
This study was undertaken to evaluate whether or not an educational pamphlet could
improve knowledge without increasing anxiety in women with preeclampsia.
Methods:
One hundred women ...recruited from an inpatient setting with suspected or proven
preeclampsia were asked to answer a questionnaire assessing demographics,
knowledge (primary outcome), anxiety and satisfaction (secondary outcomes) after
being randomized to an intervention group (who received a pamphlet) or a control
group (who did not received a pamphlet). The pamphlet and questionnaire, both
designed by a multidisciplinary team, were read and answered at the same time.
Results:
Baseline and demographic characteristics were similar between the two groups.
Knowledge about the symptoms of pre-eclampsia was excellent in both groups (61% to
100% correct answers). Women in both groups were well aware that preeclampsia in
the past (P = 0.22) and a family history of preeclampsia
(P = 0.57) were risk factors. There was a significant
difference in knowledge about the risk of some fetal complications, including
death (90% versus 39%, P < 0.01) and all maternal
complications (P < 0.05) favouring the intervention group.
Despite increased knowledge about preeclampsia and its risks, anxiety was not
greater in the intervention group. Overall, there was a trend towards less
knowledge in vulnerable subgroups (non-white, low income and schooling levels),
but the improvement of knowledge with the pamphlet was equivalent. Baseline
anxiety was higher in the vulnerable groups, but was generally not increased by
the pamphlet.
Conclusion:
An educational pamphlet for women with suspected preeclampsia was able to increase
knowledge without increasing anxiety.
Objective:
The aim of this study is to assess the diagnostic accuracy of the spot urine
protein/creatinine ratio compared with the 24-hour urine protein in pregnancy.
Study Design:
In this ...prospective cohort study of inpatient pregnant women, the
protein/creatinine ratio and dipstick protein were assessed from a single urine
sample collected at the start of the 24-hour urine. Both tests were compared with
the 24-hour urine protein for correlation and test characteristics.
Results:
In the 196 specimens analysed, we found a strong correlation between the spot
urine protein/creatinine ratio and 24-hour urine protein (r
2 = 0.78, P < 0.01). A protein/creatinine ratio
<0.1 ruled out significant proteinuria (≥300 mg/day) with sensitivity and
negative predictive value 100%. A protein/creatinine ratio ≥0.4 detected
significant proteinuria (specificity and positive predictive value of 100%). A
protein/creatinine ratio ≥4.6 had a specificity and positive predictive value of
100% for detecting severe proteinuria (≥5000 mg/day). Urine dipsticks correlated
poorly with the 24-hour urine protein (r
2 = 0.40, P = 0.826). Nineteen percent of dipsticks
reading nil or trace were false-negative results.
Conclusion:
The spot urine protein/creatinine ratio correlated well with the 24-hour urine
protein and performed better than the urine dipsticks. Significant proteinuria in
pregnancy was excluded if the protein/creatinine ratio was <0.1 and identified
when it was ≥0.4.
The present study examined the rate of documentation of inquiry about domestic violence status by 3rd year internal medicine residents who participated in an ambulatory and inpatient general medicine ...consult service. Between 6 and 16 consults for each resident were randomly selected and reviewed for the presence of somatic complaints that are believed to be markers of potential domestic violence (DV). Of the 674 consults reviewed for documentation of inquiries regarding whether the woman was or had been a victim of DV, 92.7% were classified as appropriate for domestic violence screening. In only 9 of the 674 consults reviewed was the presence or absence of DV noted. The findings of this study suggest that third year residents on consultative services at our center are not documenting DV screening as part of their evaluation of women with somatic complaints that have been associated with DV.
Diabetes insipidus, which presents with polyuria, polydipsia, and profound electrolyte abnormalities, occurs rarely in pregnancy. We report a patient with severe oligohydramnios that resolved after ...treatment of diabetes insipidus.
A 14-year-old girl was admitted at 33 weeks' gestation with cramping and vaginal spotting. A sonogram indicated oligohydramnios and an amniotic fluid index (AFI) of 2.6, with normal fetal kidneys and bladder. On hospital day 2, the AFI was 0.0. Recorded fluid was 8 L in and 13.6 L out. Serum sodium was 153 mEq/L. Diabetes insipidus was diagnosed and treated with intranasal desmopressin acetate. The oligohydramnios resolved rapidly, and the patient delivered a healthy 2700-g male infant at 38 weeks.
Although rare, diabetes insipidus may present initially in pregnancy and should be considered in patients with oligohydramnios. Simple diagnosis with determination of 24-hour urine volume and serum electrolytes can identify this potentially reversible cause of oligohydramnios and poor obstetric outcome.
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