Impact of Intensive Care Management of Life Threatening Asthma on Feto-Maternal Outcome

Abstract

Background: The pregnant patient with medical complications represents a unique challenge to the intensive care specialist and often requires the management expertise of several subspecialists. Aim: to evaluate the impact of intensive care management on the maternal and fetal outcomes in pregnant women with life threatening asthma. Patients and methods: Twenty six obstetric patients with life threatening asthma admitted to the maternal intensive care unit (MICU) of Woman′s Health Hospital during a 2-year Period from January 2010 through May 2012 were included in this study. Data collected included asthma history, ICU management, maternal and fetal outcome. Results: All patients had history of persistent asthma (mild 27%, moderate 50%, severe 13%); most were receiving inhaled β agonist and corticosteroid preparations before the life threatening attack. Five only stopped taking any medications during pregnancy. Controlled mechanical ventilation was required in 5 patients (19%). The severity of hypercapnia ranged from 48 to 82 mm Hg. Two cases had preclampsia, 2 gestational diabetes, vaginal bleeding and premature rupture of membrane in one case and preterm birth in 2 cases. Twenty two cases were delivered by C.S (85%). Conclusions: Obstetric patients with asthma are at risk for the development of life-threatening status asthmaticus, requiring MICU admission. The need for close interdisciplinary communication between obstetricians, intensivist and chest physicians to optimize maternal and fetal outcome is emphasized.