TOG Flashcards
What is the DD of breathlessness in pregnancy?
1- anxiety / hyperventilation
2- Respiratory:
Asthma / pneumonia thromboembolic disease
pneumothorax
amniotic fluid embolism
3- Cardiac: arrhythmia/ cardiomyopathy
4- endocrine: thyrotoxicosis
Diabetes: in acute ketoacidosis
5- hematological: anaemia
6- Renal : metabolic acidosis due to acute renal failure
What is the definition of Asthma?
Chronic inflammatory disease of the airway, characterized by: intermittent episodes of wheeze, shortness of breath, chest tightness, cough, which often worse at night.
What is the prevalence of asthma in pregnancy?
(4- 12 %)
The most common chronic condition in pregnancy
What is the effect of pregnancy on asthma?
1/3 worsens
1/3 improves
1/3 has no effect
What are the main triggers of Asthma?
1- allergens: pollen/ dust / mite
2- smoking
3- exercise
4- Drugs: aspirin + B-blockers
5- food : diary/ alcohol/ peanut
6- medical conditions: rhinitis +gastric reflux
7- hormonal: premenstrual/ pregnancy
What are the main triggers of Asthma?
1- allergens: pollen/ dust / mite
2- smoking
3- exercise
4- Drugs: aspirin + B-blockers
5- food : diary/ alcohol/ peanut
6- medical conditions: rhinitis +gastric reflux
7- hormonal: premenstrual/ pregnancy
What is a healthy respiratory rate?
12 - 20 / min at rest
> 24 is abnormal
What is the effect of pregnancy on Asthma according to the severity of asthma?
In severe cases: asthma control deteriorates in 60% of the cases
In mild cases: asthma control deteriorates in 10 % of the cases
What are the most frequent triggers of exacerbation of asthma in pregnancy?
1- most frequent trigger : respiratory viral infections
2- poor adherence to inhaled corticosteroid therapy
🔴 exacerbations are most common between 24 w - 36 w
What is the maternal effects of asthma?
- poor asthma control 👉⬆️risk hypertension in pregnancy
- association between asthma &hypertension
- airway hyper responsiveness may be a predictor of PET
- higher frequency of CS
What is the fetal effects of asthma?
IUGR
LOW BIRTH WEIGHT
What is the management for asthma step 1 ( mild intermittent asthma?
Inhaled short acting B2 agonist as required ( e.g. salbutamol \ terbutaline)
What is the management for asthma step 2 ( regular preventer therapy)?
Low dose inhaled corticosteroid
( e.g. beclomethasone or budesonide 200 mcg / twice daily)
What is the management for asthma step 3 ( initial add on therapy)?
Low dose inhaled corticosteroid
& inhaled long acting B2 against (LABA) ( e.g. salmeterol or formeterol)
🚩good response: continue LABA
🚩inadequate response: continue LABA & increase inhaled steroid to 800 mcg / day
🚩 no response: stop LABA & increase steroids to 800 mcg/d
📒 When women with asthma need to be managed by obstetrician & respiratory physician ( MDT)?
Step 3 and above
What is the management of asthma step 4 ( persistent poor control)?
1- increase inhaled steroid to 2000 mcg /day
2- addition of a fourth drug:
SR Theophylline/ leucotrine receptor antagonist / B2 agonist tablet
What is the management of asthma step 5( continuous or frequent use of oral steroids)?
1- use lowest oral steroids dose providing adequate control
2- maintain high dose inhaled steroid 2000 mcg /d
3- refer patient to a specialist
📒When a step up in the treatment of asthma should be continued? ( uncontrolled)?
1- using inhaled B2 agonist 3 times/week
2- symptomatic 3 times/ week or more
3- waking 1 night a week
📒What is the maternal & fetal effects of inhaled ( steroids & long / short B2 agonist & theophylline)?
DON’T increase the maternal or neonatal outcomes such as PET , fetal congenital malformation , low birth weight or preterm delivery
📒what is the role of long acting B2 agonist alone (in the absence of inhaled steroid ) in controlling asthma?
They always should be used together
Which asthma medications should be monitored ( the serum levels) during pregnancy?
Theophylline
Because pregnancy might affect the pharmacokinetics of theophylline
📒What is the role of leucotrine modifiers in the management of asthma in pregnancy?
Good safety profile BUT there is a paucity of data
Therefore: avoid or substitute:
Prior to pregnancy
At the beginning of pregnancy
What is the management of asthma exacerbations in pregnancy?
1- oxygen ( pao2>94%)
2- oral steroids
3- nebulised B2 agonist
*Further management: inhaled anticholinergic ( ipratropium bromide) / IV B2 agonist/ IV steroids
IV MGSO4
CONTINUOUS CTG
📒how many women will experience an exacerbation of asthma during labour?
Less than fifth
📒how many women will experience life threatening exacerbation of asthma during labour?
Rare
What medications that usually used in peripartum that can cause bronchospasm?
📒Prostaglandin F2a (Dinoprost)
BUT;
*prostaglandin E2 is not associated with bronchospasm
* ergomethrin & syntometrine may cause bronchospasm and should be used with caution
When women who have been on regular oral steroids require parenteral steroids during labour?
When the dose > 7.5 mg / day
👉 hydrocortisone 60-100 mg/ 6-8h
What mode of anaesthesia is preferred in women with asthma?
Regional anaesthesia less chance of bronchospasm
Postnatal management of women with asthma should be done in the primary care , when to be managed ny respiratory physician?
📒In severe cases , of systemic steroids are considered
How to reduce the risk of the baby developing asthma?
By encouraging breastfeeding
