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Chest diseases in pregnancy 

Chest diseases in pregnancy

Chapter:
Chest diseases in pregnancy
Author(s):

Minerva Covarrubias

and Tina Hartert

DOI:
10.1093/med/9780199204854.003.1408
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date: 28 April 2017

Respiratory changes in pregnancy include an increase in tidal volume and minute ventilation, leading to a primary respiratory alkalosis. During a normal and uncomplicated pregnancy many women experience the sensation of dyspnea, hence it is important—but sometimes difficult—for the clinician to distinguish breathlessness resulting from normal physiological changes from that caused by underlying medical diseases.

Chest conditions arising in pregnancy—these include (1) amniotic fluid embolism—unique to pregnancy; (2) venous air embolism—a rare condition that can occur in pregnancy; (3) venous and pulmonary thromboembolism—pregnancy is a risk factor (see Chapter 14.7); (4) pulmonary oedema—this can be caused by heart disease, as in the nonpregnant state, but it can also be associated with pre-eclampsia or HELPP syndrome and be induced by tocolysis; (5) varicella pneumonia—the risk of this potentially devastating complication of primary varicella zoster virus infection (50% require mechanical ventilation, of whom 25% die) occurs particularly in the second or third trimester; (6) influenza—associated with high maternal morbidity.

Pregnancy in women with known chest disorders—(1) asthma—patients with a history of admission to an intensive care unit for asthma, prior mechanical ventilation, or frequent health care visits, are at risk of developing severe or life-threatening asthma exacerbations during pregnancy. The treatment of chronic asthma and acute asthma exacerbations during pregnancy is largely the same as in the nonpregnant state.

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