Bonus Material-08_2025PBRPregnancyandWomensHealthLevine

Pdf Summary

This presentation by Dr. Stephanie M. Levine reviews pulmonary and cardiovascular physiology in pregnancy, management of common pulmonary diseases during pregnancy, critical care complications, and lymphangioleiomyomatosis (LAM).<br /><br />Pregnancy causes notable respiratory changes: increased tidal volume and minute ventilation, mild respiratory alkalosis, and unchanged vital capacity. Cardiovascularly, cardiac output increases by 30-50%, systemic vascular resistance decreases, and blood volume expands by 35-50%, causing dilutional anemia. These adaptations can lead to symptoms like dyspnea and increased sleep-disordered breathing. <br /><br />Asthma affects 2-13% of pregnancies and can worsen maternal and fetal outcomes. The "1/3 rule" indicates asthma may improve, worsen, or remain stable during pregnancy. Management follows GINA 2025 guidelines, emphasizing continuation of inhaled corticosteroids (budesonide preferred) and avoidance of step-down therapy during pregnancy. Biologics such as omalizumab are generally safe if already started but should not be initiated during pregnancy.<br /><br />Venous thromboembolism (VTE) is a leading cause of maternal mortality, occurring more frequently postpartum and on the left leg. Diagnosis involves Doppler ultrasound (more effective in left lateral decubitus) and pregnancy-adapted algorithms including D-dimer levels. Low-molecular-weight heparin (LMWH) is the preferred treatment throughout pregnancy and postpartum, while warfarin and NOACs are contraindicated.<br /><br />Tuberculosis in pregnancy is treated primarily with isoniazid, rifampin, and ethambutol; pyrazinamide is not routinely recommended due to uncertain fetal safety. Close monitoring and pyridoxine supplementation are important.<br /><br />Critical care issues include amniotic fluid embolism, tocolytic pulmonary edema (from beta-2 agonists), pulmonary hypertension, and aspiration, each requiring specific supportive treatments.<br /><br />LAM is a rare, progressive cystic lung disease affecting women of reproductive age, driven by mTOR pathway mutations. It presents with dyspnea, recurrent pneumothorax, chylous effusions, and kidney angiomyolipomas. Diagnosis involves HRCT and VEGF-D levels; treatment includes sirolimus to stabilize lung function, avoidance of estrogen, and lung transplantation when needed.<br /><br />Key takeaways include familiarity with pregnancy-induced pulmonary changes, safe management of asthma, VTE, and TB, recognition of critical care complications, and awareness of LAM’s clinical features and treatment.

Meta Tag

Concept Pregnancy

Concept Asthma

Concept Venous Thromboembolism

Concept Tuberculosis

Concept Lymphangioleiomyomatosis

Concept Acute Respiratory Failure

Keywords

pregnancy physiology

pulmonary changes

cardiovascular adaptations

asthma management

venous thromboembolism

tuberculosis in pregnancy

critical care complications

amniotic fluid embolism

lymphangioleiomyomatosis

sirolimus

Pregnancy

Asthma

Venous Thromboembolism

Tuberculosis

Lymphangioleiomyomatosis

Acute Respiratory Failure