tailieunhanh - Critical Care Obstetrics part 35

Critical Care Obstetrics part 35 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Severe Acute Asthma Figure Lung volumes. Inspiratory reserve I I Tidal volume I I Residual volume Expiratory reserve Table Exacerbation and hospitalization rates in pregnancy based upon severity in a large prospective observation cohort study. Mild asthma Moderate asthma Severe asthma Asthma exacerbation rate Asthma hospitalization rate From Dombrowski MP et al. 1 . Effect of pregnancy on asthma The classic statement in regards to the impact of pregnancy on asthma is the one-third rule one-third improve one-third worsen and one-third remain unchanged. This generality is supported by several recent studies 25 1 . Dombrowski et al. have the most detailed information in their recent prospective study where the asthma group was subdivided by severity 1 . They found that in general 23 improved worsened and remained unchanged 1 . It was also noted that as severity increased so did the rate of exacerbation and need for hospitalization 1 Table . Exacerbations are most frequent from 17-24 weeks and appear to be less severe during the last 4 weeks of pregnancy 26-31 . Effect of asthma on pregnancy The effect of asthma on pregnancy is an area of ongoing debate with some studies showing little to no impact and others suggesting significant risk. Early studies evaluating the impact of asthma on pregnancy outcome showed significant adverse effect. The majority of these papers were retrospective and were based on birth certificate data 32 33 . Patients were classified according to the presence or absence of the diagnostic code for asthma and not on the severity of the asthma. These studies showed an increased risk of preterm birth low birth weight pregnancy- induced hypertension preeclampsia hemorrhage perinatal mortality and congenital malformations in patients with asthma 2 27 32 34 35 . The findings were supported by Liu et al 36 . in a retrospective cohort study which employed an administrative database with over 2000 .

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