SESSION TYPE: ICU Safety and Quality Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Restrictive lung disease is relatively uncommon in pregnancy, and limited data are available to direct peri-partum and post-partum management of patients with severe disease. This study reviewed the course of pregnant patients with severe restrictive lung diseases, in our tertiary care referral centre over the past 10 years.
METHODS: Patients with Forced Vital Capacity (FVC] < 70% predicted were identified from office charts. Retrospective review of office and hospital records was performed.
RESULTS: We identified 12 patients with 15 pregnancies. Causes of restrictive disease included kyphoscoliosis (6 patients), neuromuscular disease (2), and parenchymal lung disease (4). FVC ranged from 20% to 68% predicted (median 40%). During the course of pregnancy, about half the patients demonstrated some improvement in FVC and half a deterioration, although in many cases the change was small. Improvement in FVC ranged from 0.02L to 0.4L (median 0.1L) and deterioration ranged from 0.01 to 0.3L (median 0.12L). There were no clear parameters which could identify which patients improved versus deteriorated, but the patients with muscular disease both showed deterioration. Oxygen saturation was adequate in the majority, while 3 women required oxygen supplementation (2 with parenchymal lung disease). One woman with severe muscular disease (FVC 25% predicted) required intermittent noninvasive ventilation during both pregnancies. Three patients had mild pulmonary hypertension on echo.. Premature delivery (31 to 36 weeks) occurred in 9 pregnancies. Five deliveries were vaginal with 10 by C-section (8 elective, 2 following planned vaginal delivery). Neuraxial anesthesia was used in all but 5, who required general anesthesia for C-section due to difficult spinal anatomy. Noninvasive ventilation was used during 3 other deliveries. There was no maternal mortality and two women required ICU admission postpartum. Eleven neonates required intensive monitoring.
CONCLUSIONS: Severe restrictive lung disease can be tolerated even in the face of very poor lung functions.
CLINICAL IMPLICATIONS: The involvement of a multidisciplinary healthcare team, and a carefully planned pregnancy and labour is essential to good outcome.
DISCLOSURE: The following authors have nothing to disclose: Carolyn Tram, Stephen Lapinsky, Cynthia Maxwell
No Product/Research Disclosure InformationMount Sinai Hospital, Toronto, ON, Canada