Mw. Tomlinson et al., DOES DELIVERY IMPROVE MATERNAL CONDITION IN THE RESPIRATORY-COMPROMISED GRAVIDA, Obstetrics and gynecology, 91(1), 1998, pp. 108-111
Objective: To describe the effect of delivery on respiratory status an
d outcome in the respiratory-compromised pregnant woman. Methods: Duri
ng 1990-1994, 10 patients requiring intubation for respiratory comprom
ise who delivered during ventilatory support were identified by Intern
ational Classification of Diseases, Ninth Revision codes. Charts were
reviewed retrospectively for cardiorespiratory variables and outcome.
Results: Pneumonia led to intubation in all but one case. The onset of
labor was spontaneous in eight. Three were delivered by cesarean. Mec
hanical ventilation was used for a median (range) of 7 (2-22) days in
surviving patients. Fraction of inspired oxygen requirements decreased
an average of 28% by 24 hours after delivery. Positive end-expiratory
pressure requirements remained unaltered. Surviving patients remained
intubated for a median (range) of 2.6 (1-19) days postpartum. Three w
omen died, all after vaginal delivery (days 4-14). Conclusion: Deliver
y of respiratory-compromised gravidas resulted in a 28% reduction in f
raction of inspired oxygen requirement within 24 hours after delivery.
Although most patients were then able to be maintained below critical
fraction of inspired oxygen requirement levels (under 0.6), dramatic
improvement in overall respiratory function was not observed uniformly
. Given the limited benefit of delivery on maternal oxygenation, along
with the inherent risks of labor induction in this critically ill pop
ulation, caution should be exercised in initiating the induction proce
ss electively.