Book of Medical Disorders in Pregnancy - Tintash

Zl L-ong acting inhaled fJ-agonists such
as salmeterol are now being introduced
in Europe. It seems sensible practice to
avoid new drugs for asthma during
pregnancy. It should be remembered that
both oral steroids and oral fJ-agonists
influence glucose metabolism. Neither
oral nor inhaled fJ-agonists have been
demonstrated to delay the onset or slow
the progress of labour. Inhaled fJagonists
must not be withheld during
labor. Ergometrine has been reported to
cause bronchospasm and should be
avoided. Breast feeding is safe with
asthma me-dication.
Objective measurements of airways obstruction,
like peak flow measure-ments,
are essential. Asthma is usually worse
during the night and early morning; a
pregnant woman seen in normal working
hours may appear well but still have
severe asthma with profound sleep disturbance.
It is these individuals with
wide diurnal swings of airways calibre
who are at greatest risk of sudden catastrophic
deterioration; excellent daytime
lung function may be present, but the
risk to mother and fetus is high.
2. Pneumonia:
The incidence of pneumonia in pregnancy
is rising again. Berkowitz & La-
Salle reported pneumonia in 1 in 367
deliveries. LaSalle suggest that in their
population this rise is at least in part
attributable to human immunodeficiency
virus (HIV) infection and drug abuse. It
has been suggested that pneumonia is
commoner in pregnancy than in the nonpregnant
state, and that this may be due
to the depression of cellmediated immunity
that occurs during pregnancy. In
varicella pneumonia during pregnancy,
both maternal and fetal mortality is high.
104
28 The outcome may be improved by the
early use of intravenous acy-clovir. Nonimmune
pregnant women ex-posed to
varicella should receive varicella-zoster
immune globulin. Physical signs in the
chest may be scanty or even absent and a
cursory examination may be falsely reassuring.
If there is any clinical suspicion
of a respiratory disorder, chest radiography
must not be omitted simply
because a woman is pregnant. Even experienced
Clinicians can miss cyanosis
and blood gas analysis can reveal
profound hypoxia in patients who
superficially look well. Pneumococcal
pneumonia (which can present with a
sudden onset of breathlessness, pleuritic
pain, hemoptyses and circulatory collapse)
can all too easily be mistaken for
pulmonary thromboembolism. In the
latter case the central venous pressure
will be raised rather than the low values
likely to accompany infection. Penicillins,
cephalosporins and erythromycin
are safe in pregnancy, but tetracyclines
and aminoglycosides should be avoided.
3. Acquired immune deficiency
syndrome:
The immunosuppression associated with
the progression of HIV infection to
AIDS means that such individuals are at
increased risk of Pneumocystis carinii
pneumonia (PCP), tuberculosis, Mycobacterium
avium-intracellulare infection,
cytomegalovirus and other opportunistic
infections. The antiretroviral drug zidovudine
prolongs survival in AIDS and
advanced AIDS related complex, but
there is debate about its role in slowing
progression from HIV seropositivity to
AIDS. It appears to be safe in
pregnancy. Cotrimoxazole is safe in
pregnancy. HIV infected pregnant
women with a history of PCP or a low