Asthma in Pregnancy

During pregnancy some amount of breathlessness is common due to the effects of progesterone and fall in
arterial CO2 tension in Asthma is occurred due to hyper responsiveness of the airway to a number of irritants.
Incidence : 3-4% of all pregnant women.
Effects of asthma on pregnancy :
 Preterm labour
 PROM
 Pre-eclampsia
 IUGR
 Neonatal hypoxia
 Maternal risk ie. Status asthmaticus,
 Life threatening complications like pneumothorax, cardiac arrhythmias and respiratory failure

Management :
Pre-conception counseling :
The risk of having asthma in baby is about 4% if one parent is asthamatic. If both parents have asthma then the
risk of having asthma in child is increase to 8-16% .if the parents have allergy then risk is of 30% for child.
Care during pregnancy:
In mild case: albuterol and low dose of corticosteroid 2-3 puff 4-6 hrly are to be given to mother .
Moderate : salmetrol (long acting ) and low dose of corticosteroid 2-4 puff 4 times a day are to be given to
mother.
Severe : salmetrol, oral steroid- prednisalone 20-60mg/day and high dose of corticosteroid to be given to
mother.
Oral broncho dilator and anti inflammatory may be used for maintenance therapy.
Advice the mother for adequate rest with head elevation and frequent follow up as when require.
Care during labour:
 Assess the mother for severity of condition during labour
 Opiate analgesics are to be avoided as they are broncho-constrictor and respiratory depressant.
 Provide adequate oxygen therapy as per requirement
 Labetalol is to be avoided as it may precipitate the asthma.
 Inj hydrocortisone 100mg 8hrly IV during labour to be given.
 Inj syntocinon is better than ergometrine because it gives broncho-constrictor effect latter.
 PGF2 should be avoided it can cause broncho-spasm. PGE1 and PGE2 can be used locally for
induction of labour
 Epidural anesthesia is preferable to general anesthesia because of risk of risk of atelectasis and chest
infection.
 O2 saturation is to be assessed with pulse oxymetry or arterial blood gase analysis.
 Postnatal physiotherapy is useful to provide respiratory comfort.
Breast Feeding :
BF can be given . in case of allergic reaction can be delayed.
Contraception : Barrier method and vasectomy are preferable.