Management during labour

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

Acute attacks of asthma are very rare in labour, perhaps due to endogenous steroid production. In women receiving steroid tablets there is a theoretical risk of maternal hypothalamic-pituitary-adrenal axis suppression. Women with asthma may safely use all forms of usual labour analgesia.

Although suppression of the fetal hypothalamic-pituitary-adrenal axis is a theoretical possibility with maternal systemic steroid therapy, there is no evidence from clinical practice or the literature to support this.⁸⁵³

Advise women that an acute asthma attack is rare in labour.

[BTS/SIGN 2019]

Advise women to continue their usual asthma medications in labour.

[BTS/SIGN 2019]

In the absence of an acute severe asthma attack, reserve Caesarean section for the usual obstetric indications.

[BTS/SIGN 2019]

If anaesthesia is required, regional blockade is preferable to general anaesthesia in women with asthma due to the potential risk of bronchospasm with certain inhaled anaesthetic agents.

[BTS/SIGN 2019]

Women receiving steroid tablets at a dose exceeding prednisolone 7.5mg per day for more than two weeks prior to delivery should receive parenteral hydrocortisone 100mg 6–8 hourly during labour.

[BTS/SIGN 2019]