A Case Study of Stillbirth in a Pregnancy Complicated by Asthma

Abstract

Newcastle, NSW antenatal clinic during the first trimester, following a previously described protocol [5]. Clinical asthma severity was rated as mild, moderate or severe using the integrated severity score described in the Australian Asthma Management Guidelines [6], which closely approximate the National Heart, Lungs and Blood Institute Guidelines [7]. Appropriate inhaler use and compliance was assessed in the Asthma Management Service [8]. Results Case This is the case of a 23 year old, non-tobacco smoking, marijuana smoker with no major social problems except that her partner was unemployed. This Caucasian woman, gravidity 0, parity 0, at 34 weeks gestation presented to the Emergency Department with a severe exacerbation of asthma. She was a known asthmatic but had ceased preventer medications 2 years ago due to a reduction in her symptoms however reported that she had experienced increasing symptoms since her pregnancy. Pregnancy had been complicated with increasing reflux and heartburn although this was not disclosed in any of her antenatal visits, a mild exacerbation of her asthma at 14 weeks and anemia at 30 weeks gestation at which time she was commenced on iron replacement. The treatment that was instituted for her asthma exacerbation was not documented but her antenatal record showed the use of salbutamol on an as needed basis up to twice per day. Early gestation scan reported fetal growth was normal. Prior to her emergency presentation the patient had experienced worsening difficulty breathing and had used nebulized salbutamol in the preceding 48 hours and had used 6 x 5mg/ml salbutamol nebules during the morning before presenting to the emergency department. When she first presented to hospital she was noted to be hypoxic with saturations of 90% on room air. On examination she was afebrile, heart rate of 122 and blood pressure of 139/80. There was widespread audible wheeze in at inspiration and expiration and her examination was otherwise unremarkable. Her peak flow was 250 L/min. prior to administration of any treatment and was only improved to 280L/min post treatment with one salbutamol nebulization. She was considered to be too unwell to remain at the local hospital and was transferred to tertiary hospital for specialist care within the obstetric unit. The patient was admitted for treatment with intravenous hydrocortisone Abstract Asthma during pregnancy can be complicated by intrauterine growth restriction, preterm delivery and stillbirth. This paper reports the obstetric and respiratory history of a 23 year old woman whose pregnancy was complicated by asthma and a severe asthma exacerbation that was associated with a stillbirth at 34 weeks gestation. The article attempts to link the relationship between asthma in pregnancy and adverse fetal outcomes and therefore highlights the need for multidisciplinary care of pregnant asthmatic women and the increased need for greater awareness by health professionals and pregnant women of the use of inhaled corticosteroid (ICS) treatment during pregnancy in combination with an asthma action plan.