Flashcards in Asthma in pregnancy Deck (10)
Why is it vital that asthma is well managed in pregnancy?
- prevent asthma attacks
- ensure sufficient maternal/fetal oxygenation
- increased risk of pregnancy complications such as intrauterine growth restriction, preterm birth, hypoxia, stillbirth
- women with well managed asthma have same outcomes as non-asthmatic women
What usually happens to asthma in pregnancy?
- stays the same or improves for about 40% of women
- worsens for 60% of women - particularly between 17 and 34 weeks gestation
What prepregnancy couselling should be offered for women with asthma?
- stop smoking
- assess asthma and ensure good management prior to pregnancy
- reassure that most asthma medications are safe to continue in pregnancy
- identify triggers and discuss avoidance strategies
- encourage self-monitoring for signs of deteriorating control
- consider influenza vaccine
What is asthma?
a chronic inflammatory disease of the airways with periodic reversible airway narrowing characterised by breathlessness, wheezing, and coughing
What medications are used to treat asthma in pregnancy?
- classified as relievers and preventers
- inhaled short acting B2 agonists (SABAs) such as salbutamol and terbutaline
- inhaled long acting B2 agonists (LABAs) such as salmeterol, eformoterol
- inhaled corticosteroids such as budesonide, less evidence for others but also beclomethasone, fluticasone and ciclesonide
May also consider treatment for allergies/hayfever that may trigger asthma
e.g. seretide (combined corticosteroid and LABA), Pulmicort (budesonide inhaled corticosteroid), Ventolin (salbutamol SABA)
- treatment usually includes SABA as needed for symptom relief, then add inhaled corticosteroid and/or LABA depending on severity
What normal physiological changes in pregnancy may impact dosage of asthma medication?
- increased alveolar ventilation
- increased circulating volume
- increased particle absorption and diffusion of inhaled medications
- often less drug is required to achieve same effect as pre-pregnancy
Are asthma treatments usually considered safe in pregnancy?
- most asthma medications are considered safe in pregnancy and should be continued - both relievers and preventers
- risk of harm to baby if uncontrolled asthma or asthma attack
- risk asthma may get worse in pregnancy
- ventolin category A
- seretide category B3 (no evidence for adverse effect on baby)
What considerations are there for giving ergometrine to asthmatic women?
- ergometrine may cause bronchospasm, especially where there is general anaesthetic
- syntometrine seems to be ok as third stage prophylaxis
What intrapartum considerations are important for women with asthma?
- pain relief
- prefer regional to general anaesthesia
- continue asthma management
- maintain hydration and analgesia as required
- usually vaginal birth, occasionally with very severe asthma women may be advised to have IOL or LUSCS after 37 weeks at a time when asthma is very well controlled