Pulmonary Literature Review and Complex Case Presentations Post Graduate Course-Complex Cases- Womens Health and Pregnancy Levine

Complex Cases- Womens Health and Pregnancy Levine

Pdf Summary

This literature review by Dr. Stephanie M. Levine offers updated insights into pulmonary medicine related to pregnancy and women's health, focusing primarily on venous thromboembolism (VTE), asthma, and lymphangioleiomyomatosis (LAM). <br /><br />For VTE in pregnancy, it remains a leading cause of mortality, particularly in the postpartum period. Recent analyses highlight the cost-effectiveness of using specific guidelines, like the ATS/STR, for diagnosing suspected pulmonary embolism (PE) during pregnancy. Diagnostic strategies include the use of the D-dimer test and imaging modalities, with the Pregnancy-Adapted YEARS algorithm proving effective across all trimesters in ruling out PE without excessive reliance on CT pulmonary angiography.<br /><br />Asthma affects a significant percentage of pregnant women and can lead to severe maternal and fetal complications. Current guidelines emphasize the importance of maintaining asthma control, recommending the continuation of inhaled corticosteroids (ICS) to reduce exacerbations and prevent adverse outcomes. The Global Initiative for Asthma (GINA) 2024 guidelines advise against stepping down ICS therapy during pregnancy due to the high risk of exacerbations, while new studies support the cautious step-down under certain conditions like low eosinophilic inflammation.<br /><br />Concerning LAM, a rare disease seen almost exclusively in women, updated guidance recommends the use of sirolimus for managing this condition. It suppresses abnormal smooth muscle proliferation and is indicated in cases of significant lung function decline or chylous complications. Early intervention, rather than delayed PFT assessments, is key, and pleurodesis is advised for recurrent pneumothorax management.<br /><br />Overall, this review emphasizes evidence-based strategies and personalized treatment plans for managing pulmonary conditions in pregnant women, underlining the importance of effective and timely interventions to enhance maternal and neonatal health outcomes.

Keywords

pulmonary medicine

pregnancy

venous thromboembolism

asthma

lymphangioleiomyomatosis

D-dimer test

inhaled corticosteroids

sirolimus

maternal health

neonatal outcomes