Intrauterine Death of the Fetus Due to Accidental Carbon Monoxide Poisoning

Muller, Gulli Lindh; Graham, Sylvia

doi:10.1056/nejm195506232522505

Cited by 40 publications

(5 citation statements)

References 3 publications

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“…37 Unfortunately, fetal death can still occur even when the mother appears healthy. [4][5][6]38 The severity of damage depends on the degree and duration of hypoxia or asphyxia. Moreover, the maternal COHb level is only helpful in confirming exposure and does not predict outcomes.…”

Section: Pathophysiology Of Co In the Fetusmentioning

confidence: 99%

Smoke Inhalation Injury in a Pregnant Patient

Roderique¹,

Gebre-Giorgis²,

Stewart³

et al. 2012

Journal of Burn Care & Research

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For smoke inhalation injury of a pregnant woman, one must treat two patients and be aware of the potential effects of carbon monoxide (CO) and cyanide (CN) poisoning on both the mother and the fetus. In a pregnant woman, the size and age of the fetus and the degree of poisoning allow for tremendous variability in the toxicity of CO and CN and their respective treatment options. The authors will review a case of a 32-year-old woman who was at 37 weeks of gestation and admitted to the Evans-Haynes Burn Center after a house fire and received hydroxocobalamin (Cyanokit) for suspected CN poisoning. In addition, a review of the literature, current guidelines, and treatment options of inhalation injury during pregnancy will be discussed. The authors will focus only on the toxic components of smoke inhalation injury rather than the mechanical components from heat and particulate damage. Literature review clearly identifies that the treatment of pregnant women with inhalation injury remains a controversial subject. The use of hydroxocobalamin (Cyanokit) as a treatment modality for potential CN poisoning in a pregnant patient has not been reported in the literature. Animal studies have shown that combined CO and CN poisoning are more lethal than either one alone and at lower concentrations. Due to the synergistic effects of CO and CN, and because these two toxins concentrate at even higher levels in the fetus than the mother, the authors will clarify the urgent seriousness of prompt administration of hydroxocobalamin in a pregnant patient with suspected smoke inhalation injury. This case review details the treatment of a 32-year-old woman who was at 36 weeks of gestation on admission to the Evans-Haynes Burn Center. The authors will report her injuries and the course of treatment. Although burned and presenting with concomitant smoke inhalation injury, both the woman and her child fared well with no significant complications due to the smoke inhalation at 6 months of follow-up. Smoke inhaled from modern structural fires potentially contains both CN and CO gases. This makes the prompt recognition of this injury and selection of appropriate therapy an emergent priority. In October 2010, the Food and Drug Administration approved hydroxocobalamin for use in pregnant patients in the acute setting when CN toxicity is suspected. Because CO and CN have additive effects when both are present in the body, the prompt administration of hydroxocobalamin not only eliminates the effects of CN but also potentially attenuates its synergistic effects on CO. It is only through a better understanding of the details of smoke inhalation injury, the current treatment options, and the considerations regarding their use that new research and strong guidelines can be developed to better serve our patients.

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Section: Pathophysiology Of Co In the Fetusmentioning

confidence: 99%

Smoke Inhalation Injury in a Pregnant Patient

Roderique¹,

Gebre-Giorgis²,

Stewart³

et al. 2012

Journal of Burn Care & Research

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“…There is also evidence that the half-life of elimination of CO from the fetus is greater than that in the mother [Margulies, 19861. Peak CO concentrations measured in fires (15,000+ ppm) [Lowry et al,198.51 are immediately dangerous to an unprotected woman fire fighter and her fetus. Acute CO exposures that are non-lethal to the mother have been associated with fetal loss [Muller and Graham, 1955;Goldstein, 19651 and permanent neurologic sequelae in the fetus [Cramer, 19821. Assuming regular use of SCBA by fire fighters, this review will focus on the assessment of risk to a fetus of a mother who was chronically exposed to low levels of CO, which we will define as < 100 ppm or 6-1 1% of COHb.…”

Section: Carbon Monoxidementioning

confidence: 99%

Reproductive hazards of fire fighting II. Chemical hazards

McDiarmid

Lees

Agnew

et al. 1991

American J Industrial Med

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Studies of the health of fire fighters have historically focused on non-malignant respiratory disease and cancer. More recently, concerns have surfaced about reproductive health effects in many areas of the workforce, including fire fighting. These concerns prompted this review of chemical exposures that may contribute to adverse reproductive health outcomes in male as well as female fire fighters. A review of the industrial hygiene literature was undertaken to identify agents commonly found in fire smoke. These agents were then examined for evidence of reproductive toxicity or mutagenicity/carcinogenicity. This profile of chemical agents and their reproductive toxicities permits a qualitative determination that fire fighters are exposed to potential reproductive toxicants as a part of their normal fire fighting duties. Considerations for mitigating these risks are also discussed.

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“…1) and about the same size as in the full term infant. The most convincing examples are those rare cases of children born with neurological abnormalities after the mothers have been exposed to carbon monoxide during pregnancy (Muller and Graham, 1955). 2).…”

Section: Basal Gangliamentioning

confidence: 99%

“…There was only a mild overgrowth of brain. The most convincing examples are those rare cases of children born with neurological abnormalities after the mothers have been exposed to carbon monoxide during pregnancy (Muller and Graham, 1955). In Hallervorden's (1949) case the mother had made an unsuccessful attempt at suicide by this means when 5 months pregnant.…”

Section: Basal Gangliamentioning

confidence: 99%