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Respiratory Changes. Oxygen consumption increase 25-35%  100% in labor Minute ventilation ↑ in excess of CO2 mainly due to increased TV not RR tachypnea is considered abnormal sign Increased incidence of atelectaisis. ABG Changes. Causes of Acute Hypoxia.

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Respiratory changes
Respiratory Changes

  • Oxygen consumption increase 25-35%

    100% in labor

  • Minute ventilation ↑ in excess of CO2 mainly due to increased TV not RR

    tachypnea is considered abnormal sign

  • Increased incidence of atelectaisis



Causes of acute hypoxia
Causes of Acute Hypoxia

  • Preeclampsia / Eclampsia & HELLP

  • Hemorrhage with massive transfusion

  • Amniotic fluid & Air embolism

  • Pneumonia

  • Pulmonary edema ( cardiogenic + tocolytic )


Anticipated intubation risks
Anticipated Intubation Risks

  • Airway  edema & hyperemia

    potential need of small ETT

  • Aspiration  delayed gastric emptying

    &relaxed GE sphincter

  • Limited reserve  High VO2

    & decreased FRC


Asthma pregnancy
Asthma & Pregnancy

  • Variable course

    33% no change 35% worsening 28% improvement.

  • Interpretation of PaCO2 in light of physiologic changes

     pre existing respiratory alkalosis

  • CXR with shielded abdomen is safe when needed

  • Poorly controlled asthma during pregnancy has adverse outcome on fetus


Asthma pregnancy1
Asthma & Pregnancy

  • Treatment strategy is the same for non pregnant

  • Inhaled bronchodilator systemic steroid

  • Theophyline should be reduced in 2nd & 3rd TM  lower protein binding and higher free drug

  • In prolonged systemic steroid use

     stress dose should be given peripartum


Nippv in pregnancy
NIPPV In Pregnancy

  • 4 patients with acute chest syndrome (complication of sickle cell anemia)

  • Acute Hypoxemia PaO2/FIO2 < 200

  • Received PSV in addition to standard Rx of Acute chest syndrome

  • None required intubation , ICU stay was shorter than matched cases who were intubated

    Al Ansari Annals of Thoracic Medicine 2007


Ards mechanical ventilation
ARDS & Mechanical Ventilation

  • Low tidal volume ventilation study excluded pregnant

    Hypercapnia harm on fetus

  • Airway pressure might be high due to the compression of gravid uterus & not necessarily related to lung disease


Vte pregnancy
VTE & Pregnancy

  • Incidence 0.5-1%

  • Highest cause of mortality 1-30%

  • 2 risk factors

    Hypercoagulopathy hormonal mediated

    Stasis ( compressive effect of gravid uterus)

  • Most common site Lt Ileo-femoral vein

     US a less sensitive test than in non pregnant

  • Radiation dose of venography is <500 mcGY

    (very small risk in case of high clinical suspicion)


Vte pregnancy1
VTE & Pregnancy

  • D-dimer can be high up to four fold in normal pregnancy  can not be used

    Morse Thromb Haemost 2004

  • Fetal radiation exposure of CXR + V/Q & CTA

     <5000 mcGy

    This is 100 to 200 times < dose thought to produce a significant risk of fetal anomalies.


Utility of vq scan
Utility Of VQ Scan

  • 113 pregnant with suspected PE had VQ scan

    73% had normal scan 24% non diagnostic test

    VQ utility is much higher than non pregnant

  • No Rx given for both groups

  • No evidence of VTE in follow up of 20 months even in the non diagnostic

  • No evidence of radiation effect on fetal outcome

    Chan Archive of Int Med 2002


Vte rx
VTE RX

  • During pregnancy either UFH IV for few days then replace by LMWH or start with LMWH

  • May need larger bolus of UFH

  • IF LMWH to be used monitoring with level of anti Xa

  • Comadin can be used between GA 13 w till mid 3rd TM

    The 7th ACCP Guidelines 2004


Risk of stroke venous thrombosis
Risk Of Stroke & Venous Thrombosis

  • Retrospective review of Us delivery registry

  • 1 500 000 chart reviewed

  • Estimated stroke risk 13.1/100 000

  • IC venous thrombosis11.6 /100 000

  • Predisposing factors  C section HTN

    electrolytes & Acid base disturbances Odds Ratio >3

    Lanska Stroke 2000