Pneumonia in Pregnancy

OVERVIEW

  • 2 patients
  • treatment dependent on stage of pregnancy (first trimester: avoidance of teratogenicity, third trimester: prevention of pre-term labour)
  • signs of severe sepsis may be masked by normal pregnancy changes
  • these two patients require synchronous resuscitation, evaluation and treatment.

MANAGEMENT

  • Call for help early – obstetrics, anaesthesia, neonatal team

Resuscitate

  • A – intubate if indicated, may be difficult, call for help early
  • B – consider NIV, avoid permissive hypercapnia c/o fetal acidosis, optimize blood flow to placenta
  • C – left lateral position, fluid loading, pressors and inotropes

Early cultures and antibiotics (see below)

Evaluation and Management

Mother

  • history:

-> co-morbidities
-> pregnancy
-> previous pneumonia
-> immunosuppressed

  • examination:

-> volume status
-> complications: empyema, cerebritis
-> other organ involvement

  • investigations:

-> blood cultures
-> CXR: with protection of baby
-> sputum
-> urinary antigens (pneumococcal and legionella)
-> nasopharyngeal swab (H1N1)
-> exclude non respiratory cause of sepsis

  • management:

-> antibiotics: cefuroxime, erythromycin, oseltamivir

Baby

  • viability
  • avoid teratogenicity
  • steroids
  • assessment fetal well being (CTG, U/S)
  • consider LSCS if clinical deterioration

General management

  • nutrition
  • thromboprophylaxis (high risk patient)
  • ulcer prevention
  • aspiration prophylaxis
  • early anaesthetic consult

Disposition

  • early transfer to a tertiary unit
  • ICU admission
  • close liaison with family and teams

CCC 700 6

Critical Care

Compendium

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