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