Dr. Añover
ASTHMA
Reactive airway disease frequently seen in young
women
Estimated prevalence during pregnancy between 4
and 8 percent, appears to be rising
Evidence is accruing that fetal and neonatal
environmental exposure may contribute to the
origins or mitigation of asthma
Pathophysiology
Chronic inflammatory syndrome with a major
hereditary component
Increased airway responsiveness and persistent
subacute inflammation are associated with
polymorphism genes chromosomes 5q that include
cytokine gene clusters, beta adrenergic and
glucocorticoid receptor genes and the T-cell antigen
receptor gene.
Etiologically and clinically heterogeneous
Environmental stimulants – serves as promoter for
susceptible individuals
Hallmarks of asthma
o Reversible airway obstruction from bronchial
smooth muscle contraction
o Vascular congestion
o Tenacious mucus
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o Mucosal edema
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ZALGIATROZ 2021 S.Y. 2019-2020 AGUSTIN, AMAGO, BAJO, GERALE, IGANO, ROMPAL, POSION
Subsequent alterations in oxygenation primarily Because of hyperventilation, this may only be seen
reflect ventilation-perfusion mismatching initially as an arterial PCO2 returning to normal
because the distribution of airway narrowing is range
uneven. With continuing obstruction, respiratory failure
Hypoxia initially mitigated by hyperventilation which follows from fatigue
maintains PO2 within normal range but lowers Early asthma stages may be dangerous to pregnant
PCO2 leading to respiratory alkalosis woman and her fetus because smaller functional
With severe obstruction, ventilation becomes capacity and increased pulmonary shunting render
impaired as fatigue causes early CO2 retention the woman more susceptible to hypoxia and
hypoxemia.
o Central cyanosis
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o Altered consciousness
ZALGIATROZ 2021 S.Y. 2019-2020 AGUSTIN, AMAGO, BAJO, GERALE, IGANO, ROMPAL, POSION
Management of Chronic Asthma ACUTE BRONCHITIS
Management guidelines includes: Infection of the large airways is manifest by cough
o Patient education without pneumonitis
o Environmental precipitating factors Common in adults, especially winter months
o Objective assessment of pulmonary function Caused by Influenza A and B, parainfluenza,
and fetal status respiratory syncytial virus, corona virus, and
o Pharmacological therapy rhinovirus
Cough persist for 10-20 days and occasionally lasts
a month or longer
Routine antibiotic treatment is not indicated
PNEUMONIA
Frequent indication for postpartum readmission
Bacterial Pneumonia
Caused by Streptococcus pneumonia,
Haemophilus influenza and Legionella species
Typical symptoms:
o Cough, dyspnea, sputum production and
pleuritic chest pain
o Mild respiratory, malaise and mild leukocyotsis
precede these symptoms
Chest radiograph is essential for diagnosis
Rapid serological testing for Influenza A and B is
Management of Acute Asthma
also recommended
Similar to that for the nonpregnant asthmatic
Management:
First line therapy
o Can be safely treated as outpatient if not
o SABA
clinically severe
Antibiotics not given unless there is concomitant
o Antimicrobial and antiviral treatment is
pneumonitis
empirical
bronchospasm
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ZALGIATROZ 2021 S.Y. 2019-2020 AGUSTIN, AMAGO, BAJO, GERALE, IGANO, ROMPAL, POSION
o Mild and self-limited
o Characterized by fever and cough
o Treatment: Amphotericin B IV
TUBERCULOSIS
Infection is caused by inhalation of Mycobacterium
tuberculosis
Symptoms include:
o Cough with minimal sputum production, low
grade fever, hemoptysis, and weight loss
Various infiltrative patterns seen on chest
radiographs
Clinical improvement is usually evident in 48-72
Acid-fast bacilli are seen on stained smears of
hours with resolution of fever in 2-4 days
sputum
Prematurely ruptured membranes and preterm
Forms of extrapulmonary TB:
delivery are frequent complications
o Lymphadenitis, pleural, genitourinary, skeletal,
Prevention
meningeal, gastrointestinal and military or
o Pneumococcal vaccines (23-serotype and 13-
disseminated
serotype)
Treatment: Isoniazide, Rifampicin, Pyrazinamide
- 13-serotype is contraindicated in pregnant
and Ethambutol for 6 months
woman but recommended for women who
TB and Pregnancy
are immunocompromised
o Outcomes are dependent on the site of
infection and gestational age at diagnosis
Influenza Pneumonia
o Active pulmonary TB was associated with
Caused by influenza A and B, self-limited
increased incidence of preterm delivery, low
Onset is 1 to 4 days following exposure
birth weight and growth restricted newborns
Common symptoms
and perinatal mortality
o Fever, cough, myalgia and chills
o Treated TB is associated with good outcomes
Management
o Diagnoses:
o Supportive and antiviral treatment for
Tuberculin skin test (PPD)
uncomplicated influenza
Interferon-gamma release assay (blood
o Oseltamivir 75mg PO BID or Zanamivir 10mg
BID via inhalation for 5 days tests that measure interferon-gamma
Prevention release in response to antigen present in M.
o Vaccination for Influenza A is recommended by Tuberculosis
ACOG and CDC o Treatment:
Latent Infection – Isoniazid 300 mg PO for
Varicella Pneumonia 9 months
Infection with varicella-zoster virus Active Infection- Four drug regimen
(Rifampicin, Isoniazid, Ethambutol,
Fungal and Parasitic Pneumonia Pyrazinamide) along with Pyridoxine for 6
Pneumocystic Pneumonia months (First 2 months- all 4 drugs are
o Pneumocystis jeroveci given; then followed by 4 month phase-
o Characterized by dry cough, tachypnea, isoniazid and rifampicin)
dyspnea, and diffuse radiographic infiltrates
o Can be identified by sputum culture, SARCOIDOSIS
bronchoscopy with lavage or biopsy This is a chronic, multisystem inflammatory disease
o Most frequent HIV-related disorder in pregnant of unknown etiology characterized by an
women accumulation of T helper lymphocytes and
o Treatment: Trimethoprim-sulfamethoxazole for phagocytes within noncaseating granulomas.
14-21 days; alternative agent- Pentamidine Genetically determined and characterized by an
Fungal Pneumonia exaggerated response of t helper lymphocytes to
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immunocmpromised
20 and 40 years of age
ZALGIATROZ 2021 S.Y. 2019-2020 AGUSTIN, AMAGO, BAJO, GERALE, IGANO, ROMPAL, POSION
Clinical presentation Lung transplantation during pregnancy is less
o Dyspnea, dry cough without constitutional favorable
symptoms that develop insidiously over months
o Onset is abrupt and sometimes asymptomatic
at discovery
Interstitial pnemonitis (hallmark of pulmonmary
involvement)
Biopsy- for confirmation of diagnosis
Good prognosis; often resolves without treatment
Glucocorticoids is usually given for symptomatic
individuals
Pregnancy Outcome
o Usually uncommon and frequently benign
o Incidences of preterm delivery, preeclampsia
and thromboembolism
o Active sarcoidosis is treated using guidelines as
for nonpregnant women
o Symptomatic uveitis, constitutional symptoms
and pulmonary symptoms are treated with
prednisone 1mg/kg PO per day
CYSTIC FIBROSIS
Autosomal recessive excrinopathy
Usually diagnosed shortly after birth because of
meconium peritonitis CARBON MONOXIDE POISONING
Mutations in the chloride channel cause altered The most frequent cause of poisoning worldwide
epithelial cell membrane transport of electrolytes Odourless and tasteless and has high affinity for
and this affects all sites in which epithelium haemoglobin binding
expresses CFTR-secretory cells Pregnancy and CO Poisoning
Preconceptional Counselling o With chronic exposure, maternal symptoms
o Women with clinical cystic fibrosis are subfertile usually appear when the carbocyhemoglobin
because of tenacious cervical mucus concentration is 5 to 20 percent
o Males are infertile, have oligospermia or o Symptoms include headache, weakness,
aspermia from vas deferens obstruction dizziness, physical and visual impairment,
o Both intrauterine insemination and in vitro palpitations and nausea and vomiting
fertilization can be successful to affected o With acute exposure, concentrations of 30-50
women percent produce symptoms of impending
o ACOG recommends carrier screening be cardiovascular collapse
offered to all women currently pregnant or o Levels >50 percent may be fatal for the mother
considering conception o The fetus does not tolerate excessive exposure
o Pregnancy outcome is inversely related to o Haemoglobin F has an even higher affinity for
severity of lung dysfunction CO (10-15%) due to diffusion
Management o Half life of carboxyhemoglobin is 2 hours in the
o Serial pulmonary function testimg assits mother but 7 hours in the fetus
management and estimating prognosis o Fetus may be hypoxic even before maternal CO
o FEV1 of 70% at least, women can tolerate levels are appreciably elevated
pregnancy o Anoxic encephalopathy is the primary sequel of
o Beta adrenergic bronchodilators help control fetal exposure
airway constriction Treatment
o Inhaled recombinant human o Supportive along with 100% inspired oxygen
deoxyribonuclease – improves lung function
by reducing sputum viscosity
o Nutritional status is assessed
o Oral synthetic penicillins and
cephalosporins for staphylococcal infections
o For labor and delivery, epidural analgesia is
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recommended
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ZALGIATROZ 2021 S.Y. 2019-2020 AGUSTIN, AMAGO, BAJO, GERALE, IGANO, ROMPAL, POSION