Managing asthma in pregnancy, during labour and when breastfeeding

Asthma pathway (BTS, NICE, SIGN) [SIGN 244]
Healthcare Improvement Scotland

This content is from the BTS/SIGN British guideline on the management of asthma (SIGN 158), 2019.

Continuous fetal monitoring should be performed when asthma is uncontrolled or severe, or when fetal assessment on admission is not reassuring. Consideration should be given to early referral to critical care services as impaired ventilatory mechanics in late pregnancy can lower functional residual capacity and may result in earlier oxygen desaturation.817 Pregnant women may be more difficult to intubate due to anatomical changes especially if they have pre-eclampsia.818

 

R
In pregnant patients, give drug therapy for acute asthma as for non-pregnant patients including systemic steroids and magnesium sulphate.

[BTS/SIGN 2019]

 

R
In pregnant patients with acute asthma, deliver high-flow oxygen immediately to maintain saturation 94–98%.

[BTS/SIGN 2019]

 

R
Acute severe asthma in pregnancy is an emergency and should be treated vigorously in hospital.

[BTS/SIGN 2019]

 

Continuous fetal monitoring is recommended for pregnant women with acute severe
asthma.

[BTS/SIGN 2019]

 

For women whose asthma is poorly-controlled during pregnancy there should be close liaison between the respiratory physician and obstetrician, with early referral to critical care physicians for women with acute severe asthma.

[BTS/SIGN 2019]

 

     

References

  1. 817. Gee J, Packer B, Millen J, Robin E. Pulmonary mechanics during pregnancy. J Clin Invest  1967;46(6):945-52.
  2. 818. Izci B, Riha R, Martin S, Vennelle M, Liston W, Dundas K, et al. The upper airway in pregnancy and pre-eclampsia. Am J Respir Crit Care Med 2003;167(2):137-40.