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HYPOXIA IN PREGNANCY

Published online by Cambridge University Press:  07 June 2012

FELICITY PLAAT  and
LINDSAY ARRANDALE
FELICITY PLAAT*
Affiliation:
Imperial College School of Medicine and NHS Healthcare Trust, Queen Charlotte's Hospital, London
LINDSAY ARRANDALE
Affiliation:
Imperial College School of Medicine and NHS Healthcare Trust, Queen Charlotte's Hospital, London
*
Felicity Plaat, Imperial College NHS Healthcare Trust, Queen Charlotte's Hospital, Du Cane Road, London W12 0HS, United Kingdom. Email: [email protected]
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Extract

Hypoxia in pregnancy is rare, however the anatomical and physiological changes associated with pregnancy may exacerbate hypoxia and hypoxaemia arising from pathological processes.

In this review we seek to briefly outline the well recognised changes to the maternal airway and respiratory anatomy and physiology. We will discuss a hierarchical approach to the tests used in differential diagnoses, summarise the physical principles behind commonly used tests and identify pitfalls and considerations in their use in the obstetric population. Some of the more commonly seen pathological states that may cause hypoxia in pregnancy will be discussed.

Type
Review Article
Information
Fetal and Maternal Medicine Review , Volume 23 , Issue 2 , May 2012 , pp. 71 - 96
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1Mallampati, SR, Gatt, SP, Gugino, LD, Waraksa, B, Freiburger, D, Liu, PL. A Clinical sign to predict difficult intubation; A prospective study. Can Anaesth Soc J 1985; 32: 429–434.CrossRefGoogle ScholarPubMed
2Hawthorne, L, Wilson, R, Lyons, G, Dresner, M. Failed intubation revisited: 17yr experience in a teaching maternity unit. Br J Anaesth 1996; 76: 680–84.Google Scholar
3Hegewald, MJ, Crapo, RO. Respiratory physiology in pregnancy. Clin Chest Med 2011; 32: 1–13.CrossRefGoogle ScholarPubMed
4Camann, WR, Ostheimer, GW, Physiological adaptations during pregnancy. Int Anesthesiol Clin 1990; 28; 2–10.Google Scholar
5Widdicombe, J, Davies, A. Blood gas transport. Widdicombe, J, Davies, A, (eds). Respiratory Physiology 2nd edn. Edward Arnold, London 1983, 68–70.Google Scholar
6Prahl, S. Molar extinction coefficients of oxy and deoxyhemoglobin. URL:http://omlc.ogi.edu/spectra/hemoglobinGoogle Scholar
7Van de Louw, A, Cracco, C, Cerf, C, Harf, A, Duvaldestin, P, Lemaire, F, Brochard, L. Accuracy of pulse oximetry in the intensive care unit. Intensive Care Med 2001; 27: 1606–13.CrossRefGoogle ScholarPubMed
8Severinghaus, JW, Koh, SO. Effect of anemia on pulse oximeter accuracy at low saturation. J Clin Monit 1990; 6: 85–88.CrossRefGoogle ScholarPubMed
9Severinghaus, JW. Blood gas calculator. J Appl Physiol 1966; 21: 1108–116Google Scholar
10Brent, R. The Pulmonologist's role in caring for pregnant women with regard to the reproductive risks of diagnostic radiological studies or radiation therapy. Clin Chest Med 2011; 32: 33–42.Google Scholar
11Masip, J, Betbesé, AJ, Páez, J, Vecilla, F, Cañizares, R, Padró, J et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet 2000; 356: 2126–132.Google Scholar
12Catanzarite, V, Willms, D, Wong, D, Landers, C, Cousins, L, Schrimmer, D. Acute respiratory Distress in pregnancy and the puerperium: Causes, courses and outcomes. Obstet Gynecol 2001; 97: 760–64.Google ScholarPubMed
13Harrison, DA, Penny, JA, Yentis, SM, Fayek, S, Brady, AR. Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database. Critical Care 2005; 9: S25–37.Google Scholar
14Lam, CM, Wong, SF, Leung, TN, Chow, KM, Yu, WC, Wong, TY et al. A case-controlled study comparing clinical course and outcome of pregnant and non-pregnant women with servere acute respiratory syndrome. BJOG 2004; 111: 771–74.Google Scholar
15Cole, DE, Taylor, TL, McCullough, DM, Shoff, CT, Derdak, S et al. Acute respiratory distress syndrome in pregnancy. Crit Care Med 2005; 33: S269–S278.Google Scholar
16Acute Respiratory Distress Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301–308.CrossRefGoogle Scholar
17Lapinsky, SE. Cardiopulmonary complications of pregnancy. Crit Care Med 2005; 33: 1616–622.Google Scholar
18Cunningham, JA, Devine, PC, Jelic, S: Extracorporeal membrane oxygenation in pregnancy. Obstet Gynecol 2006; 108: 792–95.Google Scholar
19Raphael, JH, Bexton, MD. Combined high frequency ventilation in the management of respiratory failure in late pregnancy. Anaesthesia 1993; 48: 596–98.CrossRefGoogle ScholarPubMed
20Bugge, JF, Tanbo, T: Nitric oxide in the treatment of fulminant pulmonary failure in a young pregnant woman with varicella pneumonia. Eur J Anaesthesiol 2000; 17: 269–72.CrossRefGoogle Scholar
21Kenn, S, Weber-Carstens, S, Weizsaecker, K, Bercker, S. Prone positioning for ARDS following blunt chest trauma in late pregnancy. Int J Obstet Anesth 2009; 18: 268–71CrossRefGoogle ScholarPubMed
22Tomlinson, MW, Caruthers, TJ, Whitty, JE, Gonik, B. Does delivery improve maternal condition in the respiratory-compromised gravida? Obstet Gynecol 1998; 91: 108–11.CrossRefGoogle ScholarPubMed
23Jenkins, TM, Troiano, NH, Graves, CR, et al. Mechanical ventilation in an obstetric population: Characteristics and delivery rates. Am J Obstet Gynecol 2003; 188: 549–52.Google Scholar
24Goodnight, WH, Soper, DE. Pneumonia in pregnancy Crit Care Med 2005; 33: S390–97.Google Scholar
25Munn, MB, Groome, LJ, Atterbury, JL, Barker, SL, Hoff, C. Pneumonia as a complication of pregnancy. J Mat Fetal Med 1999; 8: 151–54.Google Scholar
26Yates, L, Pierce, M, Stephens, S, Mill, AC, Spark, P, Kurinczuk, JJ et al. Influenza A/H1N1v in pregnancy: an investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mothers and infants. Health Technol Assess 2010; 14: 109–82.Google Scholar
27Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunisation Practices (ACIP). MMWR 2004; 53: 1–32.Google Scholar
28Centre for Maternal and Child Enquiries. Saving Mothers’ Lives. The 8th report of the confidential enquiry into maternal deaths in the United Kingdom. BJOG 2011; 118: 124–25.Google Scholar
29Kurinczuk, JJ, Parsons, DE, Dawes, V, Burton, PR. The relationship between asthma and smoking during pregnancy. Women Health 1999; 29: 31–47.Google Scholar
30Clark, JM, Hulme, E, Devendrakumar, V, Turner, MA, Baker, PN, Sibley, CP et al. Effect of maternal asthma on birthweight and neonatal outcome in a British inner-city population. Paediatr Perinat Epidemiol 2007; 21: 154–62CrossRefGoogle Scholar
31Schatz, M, Dombrowski, MP, Wise, R, Thom, EA, Landon, M, Mabie, W. Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immunol 2003; 112: 283–88.Google Scholar
32Murphy, VE, Gibson, P, Talbot, PI, Clifton, VL. Severe asthma exacerbations during pregnancy. Obstet Gynecol 2005; 106: 1046–1054.Google Scholar
33Mabie, WC, Barton, JR, Wasserstrum, N, Sibai, BM. Clinical observations on asthma in pregnancy. J Matern Fetal Med 1992; 1: 45–50.Google Scholar
34Sims, CD, Chamberlain, GV, de Swiet, M. Lung function tests in bronchial asthma during and after pregnancy. Br J Obstet Gynaecol 1976; 83: 434–37.Google Scholar
35Tata, JL, Lewis, SA, McKeever, TM, Smith, CJP, Doyle, P, Smeeth, L et al. A comprehensive analysis of adverse obstetric and paediatric complications in women with asthma. Am J Respir Crit Care Med 2007; 175: 991–97.CrossRefGoogle ScholarPubMed
36Martel, MJ, Rey, E, Beauchesne, MF, Perreault, S, Lefebvre, G, Forget, A et al. Use of inhaled corticosteroids during pregnancy and risk of pregnancy induced hypertension: nested case-control study. BMJ 2005; 330: 230.CrossRefGoogle ScholarPubMed
37Clifton, VL, Giles, WB, Smith, R. Alterations of placental vascular function in asthmatic pregnancies. Am J Respir Crit Care Med 2001: 164: 546–53.CrossRefGoogle ScholarPubMed
38Rastogi, D, Wang, C, Lendor, C, Rothman, PB, Miller, RL. T-helper type 2 polarization among asthmatics during and following pregnancy. Clin Exp Allergy 2006; 36: 892–98.Google Scholar
39Hendler, I, Schatz, M, Momirova, V, Wise, R, Landon, M, Mabie, W et al. Association of obesity with pulmonary and non-pumonary complications of pregnancy in asthmatic women. Obstet Gynecol 2006; 108: 77–82.Google Scholar
40Murphy, VE, Clifton, VL, Gibson, PG. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes. Thorax 2006; 61: 169–176.Google Scholar
41Schatz, M, Dombrowski, MP, Wise, R, Momirova, M, Landon, M, Mabie, W. The relationship of asthma medication use to perinatal outcomes. L Allergy Clin Immunol 2004; 113: 1040–1045.CrossRefGoogle ScholarPubMed
42Pearlman, MA, Tintinalli, JE, Lorenz, RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynaecol 1990; 162: 1502–510.Google Scholar
43Weiss, HB, Songer, TJ, Fabio, A. Fetal deaths related to maternal injury. JAMA 2001; 286: 1863–868.Google Scholar
44Whittemore, R, Hobbins, JC, Engle, MA. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol 1982; 50: 641.Google Scholar
45Yentis, SM, Steer, PJ, Plaat, F. Eisenmenger's syndrome in pregnancy: maternal and fetal mortality in the 1990s. Br J Obstet Gynaecol 1998; 105: 921–22.CrossRefGoogle ScholarPubMed
46Izci, B, Vennelle, M, Liston, WA, Dundas, KC, Calder, AA, Douglas, NJ. Sleep-disordered breathing and upper airway size in pregnancy and post-partum. Eur Resp J 2006; 27: 321–27.Google Scholar
47Bourne, T, Ogilvy, AJ, Vickers, R, Williamson, K. Nocturnal hypoxaemia in late pregnancy. Br J Anaesth 1995; 75: 678–82.CrossRefGoogle ScholarPubMed
48Frankin, KA, Holmgren, PA, Jonsson, F, Poromaa, N, Stenlund, H, Svanborg, E. Snoring, pregnancy-induced hypertension and growth retardation of the fetus. Chest 2000; 17: 137–41.Google Scholar
49Goss, CH, Rubenfeld, GD, Otto, K, Aitken, ML. The effect of pregnancy on survival in women with cystic fibrosis. Chest 2003; 124: 1460–468.CrossRefGoogle ScholarPubMed
50von Ungern-Sternberg, BS, Regli, A, Bucher, E, Reber, A, Schneider, MC. The effect of epidural analgesia in labour on maternal respiratory function. Anaesthesia 2004; 59: 350–53.CrossRefGoogle ScholarPubMed
51Muammar, M, Marshall, P, Wyatt, H, Skelton, V. Caesarean section in a patient with cystic fibrosis. Int J Obstet Anesth 2005;14: 70–73.Google Scholar
52Lechtzin, N, Wiener, CM, Clawson, MSN, Chaudhry, V, Diette, GB. Hospitalisation in amyotrphic lateral sclerosis: causes, costs and outcomes. Neurology 2001; 56: 753–57.Google Scholar
53Restrick, LJ, Clapp, BR, Mikelsons, C, Wedzicha, JA. Nasal ventilation in pregnancy: treatment of nocturnal hypoventilation in a patient with kyphoscoliosis. Eur Respir J 1997; 10: 2657–658.Google Scholar
54US Department of Health and Human Services, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking Health. The benefits of smoking cessation. US Department of health and Human Services, Washington, DC, 1990.Google Scholar
55Onkden, C, Dornelas, E, Green, J. Nicotine gum for pregnant smokers. Obstet Gynecol 2008; 112: 859–67Google Scholar
56Strandberg-Larsen, K, Tinggaard, M, Anderson, AM, Olsen, J, Gronbaek, M. Use of nicotine replacement therapy during pregnancy and stillbirth: a cohort study. Br J Obstet Gynaecol 2008; 115: 1405–410.Google Scholar