Maternal Medicine - Respiratory disease

Question 1

What is the chance of an exacerbation in severe asthma during pregnancy?

Answer 1

20-30%

Question 2

What is the median life expectancy for CF?

Answer 2

45

Question 3

What is the incidence of CF and how many Caucasians are carriers?

Answer 3

1: 2500
1: 25

Question 4

How many live births a year are to CF mothers?

Answer 4

60

Question 5

What is the prevalence of asthma in pregnant women?

Answer 5

Approx 10%

Question 6

What are the physiological brochodilating/bronchoconstricting substances in pregnancy?

Answer 6

• Increase in free cortisol - may protect against triggers
• Progesterone - bronchodilating
• Prostaglandin F2alpha - bronchoconstricting

Question 7

What are the effects of asthma on pregnancy (mainly poorly controlled)

Answer 7

• Increased risk of hypertension
• LBW
• Increased rate of C/S

Question 8

What is the step-wise treatment of asthma?

Answer 8

1. Inhaled b2-agonist
2. Inhaled steroid 400mcg/day
3. LABA +/- steroids 800mcg/day
4. Inh steroid 2000mcg/day + 4th treatment (leukotriene recep antag, SR theophylline, b2 agonist tablet)
5. Daily PO steroid at lowest dose to maintain control

Step 3 or above need involvement of resp physician

Question 9

In pregnancy, by how much do women reduce the use of their inhaled CCS/b-agonists for stable disease, and PO steroids for exacerbations?

Answer 9

CCS- 23%
b-agonist - 13%
Oral CCS - 54%

Question 10

Which fetal anomaly is associated with oral corticosteroids?

Answer 10

Cleft lip/palate in T1

<0.3% increased risk

Question 11

How many women with asthma will experience an exacerbation in labour?

Answer 11

<1/5

Question 12

Which common intrapartum medications can cause an exacerbation of asthma?

Answer 12

Prostaglandin F2alpha (haemabate)
Ergometrine

Question 13

What is the postpartum course of asthma?

Answer 13

No exacerbations

Tends to revert to pre-pregnancy state within a few months