Topics covere *difference b/w normal and asthmatic bronchi *Triggering factors * Respiratory changes during pregnancy *Effects of asthma on pregnancy * Pregnancy outcomes * Clinical features *Examination *Management *Complications

1. ASTHMA IN PREGNANCY
DR.SHRUTIKA PATOND
DR . KAUSTUBH PACHADE

3. DISCUSSION WOULD BE ON
• Triggering factors
• Respiratory changes during pregnancy
• Effects of asthma on pregnancy
• Pregnancy outcomes
• Clinical features
• Examination
• Management
• Complications

4. INTRODUCTION
• Asthma is result of Chronic inflammattion of air ways that results in
air way obstruction and can be triggered by various stimuli.
• Most common chronic condition of pregnancy.
• Prevalence in general public is 4-5% in pregnancy and 1-
4%Prevalence in general public.
• Mortality 2 persons per 100000.

5. Triggering factors in Asthma
• Genetic and environmental Allergens, including ,pollens, house-dust
mites, cockroach antigen.
• Irritants, including cigarette smoke, wood smoke, air pollution, strong
odors, occupational dust, and chemicals. Medical conditions,
including viral upper respiratory tract infections, sinusitis.

6. • ALLERGENS :
• 1.Drugs and chemicals
• 2.nonsteroidal anti-inflammatory drugs, beta blockers.
• 3.Exercise
• 4.Cold air,flu rhinitis
• 5.Menses
• 6.Emotional stress

8. Respiratory changes during pregnancy
• ANATOMICAL CHANGES:
• - Upper respiratory mucosal hyperemia and edema, glandular
hyperactivity.
• - Thorax and Diaphragm : - In the 1st trimester, subcostal angle can
increase from 68-103 degrees.
• - Diaphragm rises by upto 4cm
• -Enlarging uterus

11. Pathophysiology of asthma in
pregnancy
• Inflammation of the airways with an abnormal accumulation of
eosinophils, lymphocytes, mast cells, macrophages, dendritic cells, and
myofibroblasts.
• This leads to a reduction in airway diameter caused by smooth muscle
contraction.
• Vascular congestion.
• Bronchial wall edema.
• Thick secretions.

13. • Effects of asthma on pregnancy
• Asthma during pregnancy is associated with an increased incidence of
:
• - perinatal mortality
• - increased risks of spontaneous abortion
• - hyperemesis
• - preeclampsia
• - prematurity
• - low birthweight infants

14. • Possible mechanisms for increased perinatal risks in pregnant
asthmatics are :
• - chronic hypoxia and other physiological consequences of poorly
controlled asthma
• - medications used to treat asthma.

15. Pregnancy outcomes
• Preeclampsia
• Congenital anomalies
• Foetal growth restriction
• Low birth weight
• PIH
• Ut. Haemorrhage

16. • Preterm labor
• Neonatal hypoglycaemia,
• Premature birth Seizures,
• unplanned LSCS .
• neonatal intensive care unit (ICU) admission
• Gestational Diabetes

17. Fetal effects
• The fetal response to maternal hypoxemia is decreased umbilical
blood flow, increased systemic and pulmonary vas- cular resistance,
and decreased cardiac output
• Monitoring the fetal response is, in effect, an indicator of maternal
status.

18. Clinical features

19. • Symptoms :
• 1.Shortness of breath
• 2. Wheezing
• 3. Cough(determines severity)
• 4.Chest tightness
• 5. Nocturnal awakenings
• 6. Recurrent episodes of symptoms

20. • Pulmonary findings
• 1. Diffuse wheezes – Long, high pitched sounds on expiration and
occasionally on inspiration
• 2. Diffuse rhonchi – Short, high or low pitched squeaks on inspiration
and/or expiration
• 3. Bronchi vesicular sounds
• 4. Expiratory phase of respiration equal to or more prominent than
inspiratory phase

21. Diagnosis
• Investigations
• 1. CBC – Anemia,thrombocytopenia or infection
• 2. Blood gases – to see oxygenation
• 3. X-ray chest -

22. Posteroanterior chest radiograph demonstrates a
pneumomediastinum in bronchial asthma. Mediastinal air is
noted adjacent to the anteroposterior window and airtrapping
extends to the neck, especially on the right side.

23. Management
• Preconception counselling
• During pregnancy
• Asthma exacerbation in pregnancy
• During labor

24. During pregnancy
• Step therapy of asthma:
• - Mild intermittent : Inhaled B agonists
• - Mild persistent : low dose inhaled corticosteroids
• - Moderate persistent : low dose or medium dose inhaled
corticosteroids and LABA(salmeterol)
• -Severe persistent : High dose inhaled corticosteroids and LABA

25. Asthma Exacerbation In Pregnancy
• Avoidance of asthma triggers : to minimize airway inflammation and
hyper responsiveness.
• Oxygen Inhalation : to maintain 02 saturation.
• Corticosteroids : Intravenous hydrocortisone 200mg stat and to be
repeated after 4 hrs.
• Mechanical ventilation : to avoid hypoxemia and CO2 saturation.

26. During Labor
• Clinical evaluation :
• -to predict severity
• -PEFR and FEV1 must be evaluated
• -asthma medications to be continued and fetal status to be
assessed (reassuring fetal status indicates good response)

28. Drugs Used
• Hydrocortisone : 100mg IV 8 hourly during labor and 24hrs
postpartum -Inhaled corticosteroids (fluticasone, budesonide)
prevents bronchial hyper responsiveness to allergens
• Syntocinon is better than ergometrine for induction of labor as latter
has broncho constrictor effect.
• 02 saturation is assessed