Asthma in pregnancy

Question 1

What is asthma in pregnancy?

Answer 1

Chronic inflammatory disease of airways - reversible airway obstruction and inflammation
Diagnosis must exist PRIOR to pregnancy
Most common chornic disease in preg (3-12%)
most occur 24-36w

Question 2

Sx and Ix of ashtma in pregnancy

Answer 2

Sx-
Wheeze, breathlesness, cough -worse in morning
precipated by -cold, drugs, exercise, atopy
Atopic Hx

Tachypnea, acessory muscles, prolonged expiratory, polyphonic wheeze, hyper inflated chest - acute
Severe- PEFR 33-50- HR>110, RR>25, cant complete sentence
Life threat- PEFR<33% - silent chest, cyanosis, brady, hypotense, confusion, coma

Ix - 
Peak flow (like adults), Oximetry
ABG (if CO2 normal - life threateneing)
FBC -infection?
CRp, UE, Cultures
PEFR diary for less severe

Question 3

Management of asthma in pregnancy

Answer 3

Non-acute
Regular medication (SABA, SABA+ICS, SABA+ICS+LTRA, LABA+ICS+LTRA,) continue through labour
smoke cessation
flu vaccine and monitor foetal movements daily after 28w

ACUTE-
High flow O2, sebulised salbutamol, iatropium bromide
Steroids- IV hydro and PO pred
IV Mg sulphate and senior help
Discharge when PEFR >75% of best, low diural variation, Stable on meds for 24h

Question 4

Complications and prognosis of asthma in pregnancy (for baby)

Answer 4

Prolonged hypoxia - foetal growth restriction, foetal brain injury
steroids in 1st trimester - cleft lip/palate
Pretern birth/perinatal mortality

Prognosis = 1/3 stable, 1/3 worse and 1/3 improves during pregnancy