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Sleep-disordered breathing (SDB) and obstructive sleep apnea syndrome (OSAS) are defined using the apnea-hypopnea index (AHI) from overnight polysomnography (PSG). AHI is the sum of apneic and hypopneic events per hour of sleep (1). Obstructive apneas are defined by more than 80% decrease in airflow for 10 s or more in the presence of thoraco-abdominal efforts. Hypopneas are defined by a decrease...
Many women have significant sleep complaints during pregnancy. One of the more frequent complaints is that of restless legs. Ekbom in 1945 was the first person to describe this in detail, labeled it as a “restless leg” condition and identified pregnancy as a common cause (1, 2). Further study of patients with complaints of restless legs revealed there were patients who had limb (both legs and arms)...
The prevalence of asthma among pregnant women is increasing and for many women with asthma, pregnancy leads to a worsening of their disease. This chapter will examine the complications which may occur during pregnancy, particularly focussing on exacerbations of asthma. A summary of the clinical guidelines for the management of asthma during pregnancy will be presented, along with a discussion of health...
Tuberculosis (TB) is a common infectious disease caused by Mycobacterium tuberculosis, which commonly attacks the lungs (as pulmonary TB) but can also affect other organ systems. Over one third of the world’s population now carries the TB bacterium. Not everyone infected develops active TB, and latent (asymptomatic) infection is common. TB is a problem not only in the developing world and an increasing...
Community acquired pneumonia is a common illness, and pneumonia and influenza serve as the seventh leading cause of death in the United States. In the pregnant patient, pneumonia is the most common cause of fatal non-obstetric infection (1–3). Pneumonia can have adverse consequences for both the mother and her fetus, with certain infections (particularly viral and fungal) assuming greater virulence...
The gravida state causes a profound number of biochemical, anatomical, and physiological changes throughout the gestational period. These changes impact respiratory physiology in only a minor way in females with no underlying lung disease, but in an individual with chronic pulmonary disease, any alteration in the balance of their pre-pregnancy respiratory physiology can lead to devastating consequences...
Patients with severe respiratory muscle impairment, in particular when vital capacity is below 60% of the predicted normal values, are often discouraged from becoming pregnant for fear of respiratory complications and the need for tracheostomy and invasive mechanical ventilation (1). A growing fetus can impair the functioning of weak diaphragms resulting in lower vital capacity and respiratory reserve...
Cystic fibrosis (CF) is an autosomal recessive genetic disorder with an incidence of roughly 1 in 3,200 live births in North America (1). Outcomes have steadily been improving in a magnitude that has been largely unparalleled for genetic disorders. In the last 30 years the median age of survival has moved from 14 to 32 years (2) and it is projected that an individual born today with CF, in developed...
Collagen vascular diseases (CVD) are a heterogeneous group of chronic auto-immune diseases frequently complicated by pulmonary involvement. The respiratory system may be involved in any of its components: airways, pleura, parenchyma, vessels, or respiratory muscles. However, interstitial lung disease and pulmonary hypertension (PH) are the most severe complications. CVD often affects childbearing...
Pregnancy is a hypercoagulable state accompanied by changes in maternal physiology that also contribute to an increased risk of thrombosis. Diagnosis and treatment of venous thromboembolism (deep venous thrombosis and pulmonary embolism) during pregnancy present unique challenges. In non-pregnant patients, there is ample clinical research upon which recommendations are based, but there is a paucity...
Pulmonary arterial hypertension (PAH) is a disease of unknown etiology that affects young and middle-aged woman with greater frequency than the rest of the population (1). It is characterized by an elevation in pulmonary vascular resistance (PVR) and a decrease in cardiac output (CO) that results in right-sided heart failure and reduced exercise capacity. Without treatment, it usually progresses to...
Pulmonary procedures during pregnancy are frequently needed for the evaluation and management of primary pulmonary conditions as well as systemic disorders with pulmonary manifestations. The interactions between the expected pulmonary physiological and anatomical adaptations to pregnancy, the procedure itself, and the use of conscious sedation (or general anesthesia) during pregnancy can result in...
The gravid patient will typically experience few difficulties during the course of her pregnancy. A small but significant number of pregnant patients will become ill enough to require the intensive care unit for both obstetrical and non-obstetrical problems. Therefore, the obstetrical physician must have an understanding of how to monitor and manage the critically ill pregnant patient and how to approach...
Critical illness invariably elicits special trepidation and concern whenever a pregnant patient is involved. Not only must providers struggle to restore normal physiology to the mother, but they must do so whilst providing adequate circulation, oxygenation, and ventilation to the growing fetus. Few disease processes present as great a challenge to this delicate maternal-fetal balance as Acute Lung...
Anesthesia-related maternal mortality rates have improved in the United States, but it still remains a prominent cause of maternal mortality. Anesthesia is the seventh leading cause of maternal mortality in the United States with the top six causes being embolism, hypertensive disorders, hemorrhage, infection, cardiomyopathy, and cerebrovascular accident (1). General anesthesia is more likely to be...
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