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pregnancy (GL789)
Approval
Approval Group Job Title, Chair of Committee Date
Maternity & Children’s Services Chair, Maternity Clinical 7th April 2017
Clinical Governance Committee Governance Committee
Change History
Version Date Author, job title Reason
1.0 Nov 2011 Helen Alott (Consultant Trust requirement
Obstetrician), Sunetra
Sengupta (SpR)
2.0 Oct 2014 Maged Shendy (post CCT National updates
fellow)
3.0 Feb 2017 Dr Mable Pereira (Speciality Reviewed
Dr)
Introduction
Majority of women with asthma have normal pregnancies and the risk of complications is
small in those with well-controlled asthma. During pregnancy about one third of asthma
patients experience an improvement in their asthma, one third experience worsening of
symptoms, and one third remain the same. Severe asthma tends to worsen during
pregnancy than mild asthma. Exacerbations are more common between 24 and 36 weeks.
Clinical Features
Symptoms
Breathlessness, cough, wheezy breathing, chest tightness
Triggering Factors: Pollen, animal dander, dust, cough, exercise, cold, emotion,
upper respiratory infections, medications (aspirin, beta blockers)
Signs:
Raised respiratory rate, wheeze, use of accessory muscles, tachycardia
Diagnosis:
History- Signs and symptoms, history of atopy, (personal or family)
Measurement of FEV1 and FVC by spirometry. FEV1/FVC ratio less than 0.7
indicates trial of treatment is needed.
A more than 20% diurnal variation in PFFR for 3 or more days per week during a 2
week diary is diagnostic.
Pre-pregnancy care
Women with asthma should be specifically advised NOT to stop or decrease their
asthma medication when they find they are pregnant.
Control of asthma should be optimised before conception.
Management
Antenatal
Women should be encouraged to stop smoking. Reference to smoking cessation
programs may prove helpful
Avoid known trigger factors
Reassurance regarding the asthma medications to improve compliance
Home peak flow monitoring and personalised self-management plans should be
encouraged
Counselled about indications for an increase in inhaled steroid dosage and if
appropriate given an emergency supply of oral steroids
Serial growth scans in women with severe asthma
Intrapartum
Asthma attacks are exceedingly rare in labour due to endogenous steroids
Women should not discontinue their inhalers during labour as there is no evidence
to suggest that beta 2 agonists inhalers will impair uterine contractions
Women receiving oral steroids (7.5mg/day for more than 2 weeks) should receive
parenteral hydrocortisone 50-100mg three times a day to cover the stress of labour.
PGE2 are safe to use.
Use of PGF2α to treat life threatening PPH may be unavoidable, but it can cause
bronchospasm and should be used with caution.
Ergometrine may cause bronchospasm especially when general anaesthesia is
used.
Regional rather than general anaesthesia is preferable because of the decreased
risk of chest infection and atelectasis.
Caesarean section is reserved only for obstetric indications only.
Postnatal
All the drugs including oral steroids are safe in breast feeding mothers.
The risk of atopic disease developing in the child of a woman with asthma is about
1 in 10, or 1 in 3 if both parents are atopic.
There is some evidence that breast feeding may reduce the risk of asthma in baby.
Life threatening asthma, In a patient with severe asthma any one of:
PEF <33% best or predicted
SpO2 <92%
PaO2 <8 kPa
Normal or raised PaCO2 (4.6-6.0 kPa)
Silent chest ,cyanosis, poor respiratory effort
Arrhythmia, exhaustion, hypotension, altered consciousness
References:
1. British guideline on the management of asthma October 2016
2. Handbook of Obstetric Medicine: Catherine Nelson-Piercy
3. Asthma in pregnancy:The Obstetrician and Gynaecologist Journal 2013;15:241-5