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Pulmonary Diseases in Pregnancy. Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI St. Luke’s College of Medicine WHQuasha Memorial November 9, 2009. Outline.

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slide1

Pulmonary Diseases

in Pregnancy

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009

outline
Outline

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 2

slide3

Physiologic

conditions

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009

physiologic changes
Physiologic changes

RV + ERV = FRC

Except for residual volume and lung capacities derived therefrom, the ‘s can be measured using direct spirometric techniques.

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 4

physiologic changes1
Physiologic changes

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 5

slide6

Unclear

condition

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009

unclear usual ubiquitous
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 7

slide8

Usual conditions

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009

unclear usual ubiquitous1
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 9

unclear usual ubiquitous2
unclear, usual, ubiquitous

Complication: Preterm labor20 poorly tolerated fetal hypoxemia and acidosis

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 10

unclear usual ubiquitous3
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 11

unclear usual ubiquitous4
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 12

unclear usual ubiquitous5
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 13

unclear usual ubiquitous6
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 14

unclear usual ubiquitous7
unclear, usual, ubiquitous

Viral Pneumonia

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 15

unclear usual ubiquitous8
unclear, usual, ubiquitous

Viral Pneumonia

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 16

unclear usual ubiquitous9
unclear, usual, ubiquitous

Viral Pneumonia

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 17

unclear usual ubiquitous10
unclear, usual, ubiquitous

Viral Pneumonia

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 18

unclear usual ubiquitous11
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 19

unclear usual ubiquitous12
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 20

unclear usual ubiquitous13
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 21

unclear usual ubiquitous14
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 22

unclear usual ubiquitous15
unclear, usual, ubiquitous

Barth & Harkins Modification 1991

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 23

unclear usual ubiquitous16
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 24

unclear usual ubiquitous17
unclear, usual, ubiquitous

An FEV1 <1 L, <20% of that predicted,= severe disease = hypoxia, poor response to therapy, high relapse rate.

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 25

unclear usual ubiquitous18
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 26

unclear usual ubiquitous19
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 27

unclear usual ubiquitous20
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 28

unclear usual ubiquitous21
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 29

unclear usual ubiquitous22
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 30

unclear usual ubiquitous23
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 31

unclear usual ubiquitous24
unclear, usual, ubiquitous
  • 1st 2 mos
  • 9 mos

Streptomycin : Category X in pregnancy: auditory, vestibular abnormalities, severe deafness

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 32

unclear usual ubiquitous25
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 33

unclear usual ubiquitous26
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 34

unclear usual ubiquitous27
unclear, usual, ubiquitous

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 35

slide36

Ubiquitous

condition

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009

unclear usual ubiquitous28
unclear, usual, ubiquitous

Half life of CO

Rm temp=4-6 hrs

100% O2=1 hour

Hyperbaric O2=15-

30 mins

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 37

slide38

Lay back, Launch,

Limit care

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009

lay back launch or limit care
Lay back, launch or limit care?

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 39

lay back launch or limit care1
Lay back, launch or limit care?

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 40

slide41

Model case

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009

model case
Model case

M.O.

31 y/o G2P1

10 weeks AOG

No cough or hemoptysis

Asymptomatic

Referred by pulmo:

CXR: (+) PTB, activity ?

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 42

slide43

Outcome

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009

outcome
outcome

Pulmonary Diseases in Pregnancy Ma. Asuncion A. Fernandez, MD 44

slide45

Pulmonary Diseases

in Pregnancy

Ma. Asuncion A. Fernandez, MD, FPOGS, FPSREI

St. Luke’s College of Medicine WHQuasha Memorial

November 9, 2009