TOG

Question 1

What is the DD of breathlessness in pregnancy?

Answer 1

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

Question 2

What is the definition of Asthma?

Answer 2

Chronic inflammatory disease of the airway, characterized by: intermittent episodes of wheeze, shortness of breath, chest tightness, cough, which often worse at night.

Question 3

What is the prevalence of asthma in pregnancy?

Answer 3

(4- 12 %)
The most common chronic condition in pregnancy

Question 4

What is the effect of pregnancy on asthma?

Answer 4

1/3 worsens
1/3 improves
1/3 has no effect

Question 5

What are the main triggers of Asthma?

Answer 5

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

Question 6

What are the main triggers of Asthma?

Answer 6

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

Question 7

What is a healthy respiratory rate?

Answer 7

12 - 20 / min at rest
> 24 is abnormal

Question 8

What is the effect of pregnancy on Asthma according to the severity of asthma?

Answer 8

In severe cases: asthma control deteriorates in 60% of the cases
In mild cases: asthma control deteriorates in 10 % of the cases

Question 9

What are the most frequent triggers of exacerbation of asthma in pregnancy?

Answer 9

1- most frequent trigger : respiratory viral infections
2- poor adherence to inhaled corticosteroid therapy
🔴 exacerbations are most common between 24 w - 36 w

Question 10

What is the maternal effects of asthma?

Answer 10

• poor asthma control 👉⬆️risk hypertension in pregnancy
• association between asthma &hypertension
• airway hyper responsiveness may be a predictor of PET
• higher frequency of CS

Question 11

What is the fetal effects of asthma?

Answer 11

IUGR
LOW BIRTH WEIGHT

Question 12

What is the management for asthma step 1 ( mild intermittent asthma?

Answer 12

Inhaled short acting B2 agonist as required ( e.g. salbutamol \ terbutaline)

Question 13

What is the management for asthma step 2 ( regular preventer therapy)?

Answer 13

Low dose inhaled corticosteroid
( e.g. beclomethasone or budesonide 200 mcg / twice daily)

Question 14

What is the management for asthma step 3 ( initial add on therapy)?

Answer 14

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

Question 15

📒 When women with asthma need to be managed by obstetrician & respiratory physician ( MDT)?

Answer 15

Step 3 and above

Question 16

What is the management of asthma step 4 ( persistent poor control)?

Answer 16

1- increase inhaled steroid to 2000 mcg /day
2- addition of a fourth drug:
SR Theophylline/ leucotrine receptor antagonist / B2 agonist tablet

Question 17

What is the management of asthma step 5( continuous or frequent use of oral steroids)?

Answer 17

1- use lowest oral steroids dose providing adequate control
2- maintain high dose inhaled steroid 2000 mcg /d
3- refer patient to a specialist

Question 18

📒When a step up in the treatment of asthma should be continued? ( uncontrolled)?

Answer 18

1- using inhaled B2 agonist 3 times/week
2- symptomatic 3 times/ week or more
3- waking 1 night a week

Question 19

📒What is the maternal & fetal effects of inhaled ( steroids & long / short B2 agonist & theophylline)?

Answer 19

DON’T increase the maternal or neonatal outcomes such as PET , fetal congenital malformation , low birth weight or preterm delivery

Question 20

📒what is the role of long acting B2 agonist alone (in the absence of inhaled steroid ) in controlling asthma?

Answer 20

They always should be used together

Question 21

Which asthma medications should be monitored ( the serum levels) during pregnancy?

Answer 21

Theophylline
Because pregnancy might affect the pharmacokinetics of theophylline

Question 22

📒What is the role of leucotrine modifiers in the management of asthma in pregnancy?

Answer 22

Good safety profile BUT there is a paucity of data
Therefore: avoid or substitute:
Prior to pregnancy
At the beginning of pregnancy

Question 23

What is the management of asthma exacerbations in pregnancy?

Answer 23

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

Question 24

📒how many women will experience an exacerbation of asthma during labour?

Answer 24

Less than fifth

Question 25

📒how many women will experience life threatening exacerbation of asthma during labour?

Answer 25

Rare

Question 26

What medications that usually used in peripartum that can cause bronchospasm?

Answer 26

📒Prostaglandin F2a (Dinoprost)
BUT;
*prostaglandin E2 is not associated with bronchospasm
* ergomethrin & syntometrine may cause bronchospasm and should be used with caution

Question 27

When women who have been on regular oral steroids require parenteral steroids during labour?

Answer 27

When the dose > 7.5 mg / day
👉 hydrocortisone 60-100 mg/ 6-8h

Question 28

What mode of anaesthesia is preferred in women with asthma?

Answer 28

Regional anaesthesia less chance of bronchospasm

Question 29

Postnatal management of women with asthma should be done in the primary care , when to be managed ny respiratory physician?

Answer 29

📒In severe cases , of systemic steroids are considered

Question 30

How to reduce the risk of the baby developing asthma?

Answer 30

By encouraging breastfeeding