Pulmonary Problems in Pregnancy : Clinical and Research Aspects PDF
Preview Pulmonary Problems in Pregnancy : Clinical and Research Aspects
Pulmonary Problems in Pregnancy R M ESPIRATORY EDICINE Sharon R. Rounds, , S E MD ERIES DITOR PulmonaryProblemsinPregnancy,editedbyGhadaBourjeilyandKarenRosene-Montella,2009 Pulmonary Problems in Pregnancy Edited by Ghada Bourjeily, MD AssistantProfessorofMedicine TheWarrenAlpertMedicalSchoolofBrownUniversity DepartmentofMedicine PulmonaryandCriticalCareMedicine WomenandInfantsHospitalofRhodeIsland Karen Rosene-Montella, MD ProfessorofMedicineandOb/Gyn TheWarrenAlpertMedicalSchoolofBrownUniversity ChiefofMedicine DepartmentofMedicine WomenandInfantsHospitalofRhodeIsland Editors GhadaBourjeily KarenRosene-Montella AssistantProfessorofMedicine ProfessorofMedicineandOb/Gyn TheWarrenAlpertMedicalSchoolof TheWarrenAlpertMedicalSchoolof BrownUniversity BrownUniversity DepartmentofMedicine ChiefofMedicine PulmonaryandCriticalCareMedicine DepartmentofMedicine WomenandInfantsHospitalofRhode WomenandInfantsHospitalofRhode Island Island Providence,RI Providence,RI [email protected] [email protected] ISBN978-1-934115-12-1 e-ISBN978-1-59745-445-2 DOI10.1007/978-1-59745-445-2 LibraryofCongressControlNumber:2008938362 #HumanaPress,apartofSpringerScienceþBusinessMedia,LLC2009 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten permissionofthepublisher(HumanaPress,c/oSpringerScienceþBusinessMedia,LLC,233Spring Street,NewYork,NY10013,USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarly analysis.Useinconnectionwithanyformofinformationstorageandretrieval,electronicadaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,eveniftheyare notidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyaresubject toproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoingto press,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityforany errors or omissions that may be made. The publisher makes no warranty, express or implied, with respecttothematerialcontainedherein. CoverIllustration:Figure1,Chapter22 Printedonacid-freepaper springer.com Preface Pregnancy is associated with physiologic changes that help compensate for the increasingdemandsofthefetusandplacenta.Clinically,pregnancyactsasastress test that unmasks maternal disease and may have long term implications for maternal and fetal health. General obstetricians are often hesitant to care for complex medical problems, and internists to care for pregnant patients, which may create a gap into which sick pregnant women will fall at a time when they aremostvulnerable. Investigation and treatment of pregnant patients with pulmonary disorders is oftenhinderedbybothafearofdoingharmtothefetusandbythepaucityofdata needed to make recommendations. At Women and Infants Hospital, the tertiary women’steachinghospitalatBrownUniversity,10,000deliveriesoccureveryyear. The editors of this textbook are members in the division of obstetric and consultative medicine, a group of obstetric internists and medical specialists that provide consultation to obstetricians on complex medical and pulmonary problems. Most pulmonary and critical care training programs provide little exposure to this population. Despite this, pulmonologists and intensivists are oftencalledupontoprovideconsultationtocriticallyillpregnantwomen. As editors, our hope was to gather pulmonologists, intensivists, obstetric internists, high risk obstetricians and obstetric anesthesiologists from across the globe to shed light on some common or complex pulmonary issues occurring in pregnancy.Thebook isdividedinto threeparts.Thefirstfewchaptersintroduce the reader to the normal physiologic changes that occur during pregnancy. The chapter on high altitude is included to illustrate the consequences of chronic hypoxia on maternal and fetal outcomes, to help extrapolate to the effects of chronic pulmonary conditions. The second part reviews general management principles, including diagnostic imaging and prescribing in pregnancy. The final, longest part includes multiple chapters on specific pulmonary disorders. The specific chapters are intended to summarize the available literature, linking science to bedside, and make management recommendations whenever possible. Ourgoalisthatthecarefulreadingofthistextwillstimulatefurtherinvestigation intothisfascinatingandunderexploredareaofmedicine. GhadaBourjeily,MD KarenRosene-Montella,MD v Contents Preface.................................................................................. v Acknowledgments .................................................................... ix Contributors........................................................................... xi PartI. NormalPregnancy ......................................................... 1 1 PhysiologicalTransitionfromFetaltoNeonatalLife inPregnancy ..................................................................... 3 AlanR.Leff 2 RespiratoryPhysiologyinPregnancy ........................................ 19 MeredithC.McCormackandRobertA.Wise 3 HighAltitude,ChronicHypoxia,andPregnancy .......................... 27 GhadaBourjeily 4 SleepPhysiologyinPregnancy ................................................ 37 GhadaBourjeilyandVahidMohsenin PartII. GeneralManagementPrinciplesinPregnancy......................... 57 5 DiagnosticImaginginPregnancy............................................. 59 MargaretMillerandLuciaLarson 6 PrescribinginPregnancyandLactation ..................................... 71 NiharikaMehta,JillNewstead-AngelandRaymondO.Powrie 7 MonitoringFetalWell-BeingintheCriticalCareSetting................. 89 KristenCotterandMathewSermer 8 AnestheticConsiderationsinPregnantPatientswith PulmonaryDisorders........................................................... 107 RichardN.Wissler vii viii Contents PartIII. PulmonaryDisordersinPregnancy .................................... 121 9 ObstructiveSleepApneainPregnancy....................................... 123 KathleenAkgunandFrancoiseJ.Roux 10 RestlessLegsSyndromeandPeriodicLimbMovement DisorderinPregnancy.......................................................... 135 KelvinLamandCarolynM.D’Ambrosio 11 AsthmainPregnancy........................................................... 143 VanessaE.MurphyandPeterG.Gibson 12 TuberculosisandPregnancy................................................... 165 JohnB.BassandJamesN.Byrd 13 PneumoniainthePregnantPatient........................................... 177 SamarKhanandMichaelS.Niederman 14 ChronicPulmonaryDiseaseandPregnancy ................................ 197 ShirleyF.Jones,MarieM.BudevandAlejandroC.Arroliga 15 NeuromuscularandChestWallDiseasesinPregnancy ................... 213 JohnRobertBachandJesu´sSancho 16 PregnancyandtheCysticFibrosisPatient .................................. 227 SamirMalhotraandPearceG.Wilcox 17 PulmonaryComplicationsofCollagenVascularDisease inPregnancy ..................................................................... 239 Ste´phaniePouwels-Fry,IsabelleTillie-LeblondandBenoıˆtWallaert 18 VenousThromboembolisminPregnancy.................................... 253 KarenRosene-MontellaandGhadaBourjeily 19 PulmonaryArterialHypertensioninPregnancy............................ 285 BrianCasserlyandJamesR.Klinger 20 PulmonaryProceduresDuringPregnancy................................... 313 MuhannedAbu-Hijleh 21 CriticalIllnessinPregnancy ................................................... 331 D.KyleHogarthandJesseHall 22 AcuteLungInjuryinPregnancy.............................................. 355 NualaJ.MeyerandGregoryA.Schmidt 23 AirwayManagementandMechanicalVentilation inPregnancy ..................................................................... 385 UmaMunnur,VenkataDPBandiandMichaelA.Gropper Index.................................................................................... 405 Acknowledgments GhadaBourjeily.Myheartfeltgratitudeanddeepestappreciationtomyhusband Fadlo,andmychildrenChristopherandNayafortheirtremendoussupportand understanding through the time it took to get this work to completion; to my motherandlatefather,fortheirencouragementandnurturing;GwenLarivierefor hertechnicalandsecretarialassistancewiththistextbook. IamalsoindebtedtoDr.MichaelPaglia,ahighriskobstetricianatWomenand InfantsHospitalofRhodeIslandandBrownUniversityandDr.MatthewSermer, a high risk obstetrician at Mount Sinai Hospital and University of Toronto for theirassistancewithobstetricalandfetalissues. Lastbutnotleast,IamdeeplygratefultoDr.AbrahamRudolph,aperinato- logistandfetalphysiologistattheUniversityofCalifornia,SanFrancisco,forhis invaluableguidanceandhelpwithfetalmatters. KarenRosene-Montella.MymostsinceregratitudetomyhusbandMark,and mychildrenBrianandJuliawhohavesharedmewithacademicmedicineformany years;Dr.AlanLeffforhissupportandencouragement;DoreenHoogasianforher secretarialandtechnicalassistance. ix Contributors Muhanned Abu-Hijleh, MD, FCCP, Interventional Pulmonology and Special Procedures Unit, The Division of Pulmonary, Critical Care and Sleep Medicine, RhodeIslandHospital,TheWarrenAlpertMedicalSchoolofBrownUniversity, Providence,RI Kathleen Akgun, MD, Pulmonary and Critical Care Section, Yale School of Medicine,NewHaven,CT Alejandro C. Arroliga, MD, Division of Pulmonary Medicine and Critical Care Medicine,ScottandWhiteHospital&Clinic,TexasA&MUniversityHealthand ScienceCenter,Temple,TX John Robert Bach, MD, Department of Physical Medicine and Rehabilitation, The New Jersey Medical School, University of Medicine and Dentistry of New Jersey,NewarkNJ VenkataDPBandi,MD,DepartmentofMedicine,PulmonaryandCriticalCare, BaylorCollegeofMedicine,Houston,TX John B. Bass, Jr., MD, Department of Internal Medicine, College of Medicine, UniversityofSouthAlabama,Mobile,AL Ghada Bourjeily, MD, Department of Medicine, The Warren Alpert Medical School of Brown University, Women & Infants Hospital, Pulmonary and Critical CareMedicine,Providence,RI MarieM.Budev,DO,MPH,TheClevelandClinic,Cleveland,OH James N. Byrd, Jr., MD, Division of Pulmonary Medicine, University of South Alabama,Mobile,AL Brian Casserly, MD, Division of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence,RI Kristen Cotter, MD, MPH, Department of Obstetrics and Gynecology, Women andInfantsHospitalofRhodeIsland CarolynM.D’Ambrosio,MD,MS,DABSM,TheCenterforSleepMedicine,Tufts- NewEnglandMedicalCenter,TuftsUniversitySchoolofMedicine,Boston,MA xi
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