Uncontrollable Life-Threatening Status asthmaticus – An Indicator for Termination of Pregnancy by Cesarean Section

Gelber, Moshe; Sidi, Yechezkel; Gassner, S; Ovadia, Yardena; Spitzer, Simon; Weinberger, Abraham; Pinkhas, J

doi:10.1159/000194705

Cited by 40 publications

(15 citation statements)

References 10 publications

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“…Cases of severe life threatening asthma requiring first trimester termination have been reported and an improvement in maternal asthma within 24 h of termination has been observed [108,109]. However, the course of an individual subject's asthma during pregnancy remains unpredictable.…”

Section: The Effect Of Pregnancy On Asthmamentioning

confidence: 99%

Asthma during pregnancy: mechanisms and treatment implications

Murphy

Gibson²,

Smith³

et al. 2005

European Respiratory Journal

155

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Asthma is becoming increasingly prevalent worldwide. Numerous historical and prospective cohort studies have investigated the effects of maternal asthma on pregnancy outcome; however, the data has been conflicting and many studies have not used standard classifications for asthma severity. Overall, the literature suggests that asthmatic females are more at risk of low birth weight neonates, pre-term delivery and complications such as preeclampsia, especially in the absence of actively managed asthma treated with inhaled corticosteroids. Pregnancy with a female foetus may particularly increase the risk of these outcomes.In addition, pregnancy has an effect on the course of asthma. The risk of an exacerbation requiring medical intervention may be as high as 50% in females with severe asthma and this may further increase the risk of poor outcomes, particularly low birth weight and pre-term delivery.The mechanisms responsible for changes in asthma with pregnancy, or alterations in pregnancy outcomes due to asthma have not been thoroughly explored. Maternal inflammatory pathways may contribute to reduced foetal growth through alterations in placental function.Asthma treatment, by reducing maternal inflammation and preventing exacerbations, is safe for use in pregnant females and contributes to improved outcomes for both mother and foetus.

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Section: The Effect Of Pregnancy On Asthmamentioning

confidence: 99%

Asthma during pregnancy: mechanisms and treatment implications

Murphy

Gibson²,

Smith³

et al. 2005

European Respiratory Journal

155

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show abstract

“…Un controllable status asthmaticus may en danger both mother and fetus; how to treat this situation is an important clinical problem. It is known that asthma, which has worsened during pregnancy, improves sometimes after labor [2]; several cases were reported in which early termination of pregnancy was carried out in order to save the mother's life [5][6][7][8][9]. These reports recommended 'therapeutic' abortion or early termination of pregnancy as a life saving procedure, because of an antic ipated dramatic relief of asthma after ter mination of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Bronchoalveolar Lavage during Third-Trimester Pregnancy in Patients with Status asthmaticus: A Case Report

Munakata

Abe²,

Fujimoto³

et al. 1987

Respiration

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Bronchial asthma is not uncommon among pregnant women. Especially, uncontrollable status asthmaticus may endanger both the lives of mother and fetus. We present a case of a late-phase pregnant woman in whom life-threatening status asthmaticus was relieved by repeated bronchoalveolar lavage (BAL) under controlled ventilation, followed by successful spontaneous vaginal delivery. This case may indicate that BAL should be considered as an option in status asthmaticus complicating pregnancy before terminating the pregnancy to save the lives of mother and fetus.

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“…On rare occasions, uncontrollable lifethreatening asthma may be refractory, despite mechanical ventilation and intensive medical therapy. In such cases, termination of pregnancy may be considered as an option and has been successfully managed with termination of pregnancy by cesarean section (64,65). In cases in which patients are admitted to an ICU at Ͼ23 wks and Ͻ34 wks of gestation, steroid therapy with two doses of intramuscular (12 mg) betamethasone administrated 24 hrs apart should be considered.…”

Section: Management Of Acute Asthma During Pregnancymentioning

confidence: 99%