Pneumonia Complicating Pregnancy

Abstract

Community-acquired pneumonia (CAP) can affect pregnancy, posing risks to mother and fetus. CAP is the most common fatal nonobstetric infectious complication and a common cause of hospital readmission. Risk factors of pneumonia in pregnancy relate to anatomic and physiologic respiratory changes and immune changes. Aspiration can occur during labor, can cause life-threatening disease, and is more common in cesarean deliveries. Influenza pneumonia can cause severe disease, increasing the risk of preterm delivery, abortion, cesarean section, maternal respiratory failure, and death. CAP treatment requires considering antimicrobial appropriateness and safety, choosing therapy in line with guidelines, but considering maternal and fetal risk.

Pneumonia and pregnancy outcomes: a nationwide population-based study

“…[3][4][5][6] Pneumonia is the most frequent cause of fatal nonobstetric maternal death in the United States. [7][8][9] It is widely held that several physiologic and immunologic changes experienced during pregnancy may predispose pregnant women toward a more severe course of pneumonia, 10 which may result in greater maternal and fetal morbidity and mortality. 6,[11][12][13][14][15] The relationship between pneumonia and pregnancy outcome has long been a topic of interest among researchers.…”

Respiratory disease in pregnancy

“…Peripartum risk factors such as delivery by cesarean section can increase the risk of hospital admission for pneumonia in the postpartum period [23]. Pneumonia in pregnancy can also lead to an increased likelihood of a complicated delivery compared to pregnancies in which infection is absent [24]. Pregnant patients have several characteristics specific to pregnancy predisposing them to an increased incidence and risk of complications from pneumonia [24e27].…”

“…Fever, cough, dyspnea, and hypoxia are part of the common presentation. Some experts advise that the inpatient and ICU admission criteria for pregnant woman should be liberalized, as there is a decreased ability to tolerate hypoxia in the pregnant patient [24]. Potential indications for ICU admissions, according to the American Thoracic Society/Infectious Disease Society of America, include but are not limited to the need for mechanical ventilation, septic shock requiring vasopressors, respiratory rate of >30 breaths per minute, PaO 2 /FiO 2 ratio <250 mmHg, multilobar infiltrates, confusion or disorientation, platelets <100,000 per mm 3 , white blood cell count <400 per mm 3 , hypotension, and hypothermia [30].…”

Respiratory Disease in Pregnancy

“…These include altered T lymphocyte immunity, maternal physiologic changes such as increased oxygen consumption, hypo albuminemia and decreased oncotic pressure, elevation of the diaphragm, and a propensity for aspiration related to relaxation of sphincter tone [5]. Common etiologic agents include bacteria (streptococcus pneumonia, hemophilus influenza, atypical organisms such as mycoplasma pneumonia, chlamydophila pneumonia) and viruses (influenza, varicella).…”