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Respiratory Medications in Pregnancy

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1. CRACKCast E178 – Co-Morbird Medical Emergencies During Pregnancy

CRACKCast E178 – Co-Morbird Medical Emergencies During Pregnancy CRACKCast E178 - Co-Morbird Medical Emergencies During Pregnancy - CanadiEM CRACKCast E178 – Co-Morbird Medical Emergencies During Pregnancy In by Chris Lipp May 17, 2018 This episode of CRACKCast covers Rosen’s Chapter 178, Co-Morbid Medical Emergencies during Pregnancy. This chapter covers many complicated issues that arise during the care of pregnant patients already suffering from concomitant medical illness, and how to manage (...) these conditions balancing risks to both mother and fetus. Shownotes – Key Concepts The physiologic demands of pregnancy may cause previously occult medical conditions to become apparent and known problems to deteriorate rapidly. The physiologic adjustments of pregnancy alter the normal ranges for certain laboratory values. The adjusted values need to be considered in the interpretation of results. The possibility of pregnancy should be considered in the differential diagnosis of certain conditions, including

2018 CandiEM

2. Respiratory Medications in Pregnancy

Respiratory Medications in Pregnancy Respiratory Medications in Pregnancy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Respiratory (...) Medications in Pregnancy Respiratory Medications in Pregnancy Aka: Respiratory Medications in Pregnancy II. Background Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S. Although are no longer FDA designated, they are included here As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking III. Class B: No risk in controlled animal studies Cromolyn (Intal) ( ) ( , ) ( ) - not in Briggs (1998) Nedocromil (Tilade

2018 FP Notebook

3. Upper Respiratory Medications in Pregnancy

Upper Respiratory Medications in Pregnancy Upper Respiratory Medications in Pregnancy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Upper Respiratory Medications in Pregnancy Upper Respiratory Medications in Pregnancy Aka: Upper Respiratory Medications in Pregnancy , Cold Preparations in Pregnancy II. Background Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S. Although are no longer FDA designated, they are included here As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking III. Class B: No risk in controlled animal studies

2018 FP Notebook

4. Prevalence of asthma and respiratory symptoms during pregnancy in the middle belt of Nigeria. (PubMed)

medication in the last 12 months. None of the pregnant women smoked tobacco during pregnancy. Pregnant women with possible asthma experienced more respiratory symptoms and worsening symptoms than those without asthma (15.8% vs. 3.9%), and the most reported symptom was being awakened by shortness of breath. The majority (55.6%) with physician-diagnosed asthma had suffered an asthma attack in the current pregnancy with a median of two attacks.The prevalence of asthma and respiratory symptoms in pregnancy (...) Prevalence of asthma and respiratory symptoms during pregnancy in the middle belt of Nigeria. Information about the burden of asthma during pregnancy in Africa is scarce.To determine the prevalence of asthma and respiratory symptoms in pregnancy in Ilorin, Nigeria.This study uses the European Community Respiratory Health Survey (ECRHS) questionnaire and definitions to screen 870 pregnant women attending three hospitals for asthma.The prevalence of possible asthma (i.e. awakened by shortness

2019 Journal of Asthma

5. Hypercapnic respiratory failure during pregnancy due to polymyositis-related respiratory muscle weakness: a case report (PubMed)

Hypercapnic respiratory failure during pregnancy due to polymyositis-related respiratory muscle weakness: a case report Polymyositis is a rare medical disorder complicating pregnancy. Ventilatory muscle weakness leading to respiratory failure is an uncommon manifestation of this autoimmune disease. We report a case of life-threatening hypercapnic respiratory failure due to polymyositis-related respiratory muscle weakness in a pregnant woman.A 31-year-old, African woman in her second trimester (...) resonance imaging. Diagnosis of polymyositis was confirmed by muscle biopsy. After receiving pulse steroid, intravenous immunoglobulins, and maintenance immunosuppressive therapy, our patient's respiratory muscle function improved and she was weaned off mechanical ventilation. Despite good maternal recovery from critical illness, the fetus developed intrauterine growth retardation and distress necessitating emergency cesarian section.New-onset polymyositis during pregnancy presenting with respiratory

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2017 Journal of medical case reports

6. Vitamin D supplementation in pregnancy: how significantly does it impact on respiratory and allergic outcomes in childhood? (PubMed)

Vitamin D supplementation in pregnancy: how significantly does it impact on respiratory and allergic outcomes in childhood? 29797392 2019 02 18 2019 02 19 1399-3038 29 8 2018 12 Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology Pediatr Allergy Immunol Comment on Pacheco-González et al. 884 10.1111/pai.12924 Zaidi Mariam M 0000-0002-3935-3714 Barts and the London School of Medicine, Queen Mary University of London, London, UK (...) . Zaidi Sara S King's College London School of Medical Education, London, UK. eng Letter Comment 2018 07 17 England Pediatr Allergy Immunol 9106718 0905-6157 0 Vitamins 1406-16-2 Vitamin D IM Pediatr Allergy Immunol. 2018 May;29(3):243-253 29444346 Child Humans Hypersensitivity Vitamin D Vitamins 2018 5 26 6 0 2019 2 20 6 0 2018 5 26 6 0 ppublish 29797392 10.1111/pai.12924

2018 Pediatric Allergy and Immunology

7. The course of asthma during pregnancy in a recent, multicase–control study on respiratory health (PubMed)

The course of asthma during pregnancy in a recent, multicase–control study on respiratory health Over the years it has been widely stated that approximately one-third of asthmatic women experience worsening of the disease during pregnancy. However, the literature has not been reviewed systematically and the meta-analytic reviews include old studies. This study aimed to examine whether the prevalence of worsening asthma during pregnancy is still consistent with prior estimate or it has been (...) reduced.A detailed Clinical Questionnaire on respiratory symptoms, medical history, medication, use of services, occupation, social status, home environment and lifestyle was administered to random samples of the Italian population in the frame of the Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Only clinical data belong to 2.606 subjects that completed the clinical stage of the GEIRD study, were used for the present study.Out of 1.351 women, 284 self-reported asthma and 92

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2018 Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology

8. Twin and triplet pregnancy

not appear to be associated with an increased risk of serious neonatal adverse outcomes. Also explain that: these babies will usually need to be admitted to the neonatal unit and have an increased risk of respiratory problems continuing the pregnancy beyond 33 +6 weeks increases the risk of fetal death. [2019] [2019] 1.9.7 Explain to women with an uncomplicated trichorionic triamniotic or dichorionic triamniotic triplet pregnancy that continuing the pregnancy beyond 35 +6 weeks increases the risk (...) Twin and triplet pregnancy T Twin and triplet pregnancy win and triplet pregnancy NICE guideline Published: 4 September 2019 www.nice.org.uk/guidance/ng137 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

9. Medication use during pregnancy and lactation

of the uterus and thus increasing the risk of spontaneous abortion or preterm delivery (i.e. misoprostol) • altering blood flow to the placenta (i.e. ACE inhibitors) Some medicines should not be used close to delivery because they may affect the delivery or the newborn child (i.e. NSAIDs). For example, some newborns have respiratory problems if the woman has used benzodiazepines or opioids over time closely with birth (3). Pharmacokinetic conditions during pregnancy Serum concentrations of some medications (...) Medication use during pregnancy and lactation Medication use during pregnancy and lactation Hedvig Nordeng Marte Jettestad Prescribing medication to pregnant and lactating women requires that one also takes into consideration the safety of the fetus and breastfed child. The challenge is to provide the woman with an effective medication that does not harm the fetus or breastfed child. Recommendations • Pregnant women should in general be cautious with use of medication, especially in the first

2015 Nordic Federation of Societies of Obstetrics and Gynecology

10. Assessment of respiratory alkalosis

16;280(3):117-23. http://www.ncbi.nlm.nih.gov/pubmed/5782512?tool=bestpractice.com Santra G, Paul R, Das S, et al. Hyperventilation of pregnancy presenting with flaccid quadriparesis due to hypokalaemia secondary to respiratory alkalosis. J Assoc Physicians India. 2014;62:536-538 http://www.japi.org/june_2014/16_cr_hyperventilation_of_pregnancy.pdf Berend K, de Vries AP, Gans RO. Physiological approach to assessment of acid-base disturbances. N Engl J Med. 2014 Oct 9;371(15):1434-45. http (...) in pregnant women due to high circulating progesterone levels causing hyperventilation and respiratory alkalosis. One case report described a patient with respiratory alkalosis-induced hypokalaemia leading to flaccid paralysis. Santra G, Paul R, Das S, et al. Hyperventilation of pregnancy presenting with flaccid quadriparesis due to hypokalaemia secondary to respiratory alkalosis. J Assoc Physicians India. 2014;62:536-538 http://www.japi.org/june_2014/16_cr_hyperventilation_of_pregnancy.pdf In the acute

2018 BMJ Best Practice

11. Pregnancy Outcomes and Medical Costs According to Gestational Diabetes Mellitus Diagnostic Criteria

Pregnancy Outcomes and Medical Costs According to Gestational Diabetes Mellitus Diagnostic Criteria Pregnancy Outcomes and Medical Costs According to Gestational Diabetes Mellitus Diagnostic Criteria - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please (...) remove one or more studies before adding more. Pregnancy Outcomes and Medical Costs According to Gestational Diabetes Mellitus Diagnostic Criteria (POMEC) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03421262

2017 Clinical Trials

12. The Collaborative Assessment, OTCA12, on “C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs)

Antibiotics in Community- acquired LRTI in Europe HIV human immunodeficiency virus HRQOL health-related quality of life ICD International Classification of Diseases IVDR EU Regulation 2017/746 on In Vitro Diagnostic Devices ( the IVDR) LRTI lower respiratory tract infection LTC long-term care OOH out-of-hours OR odds ratio MeSH medical subject headings NPV negative predictive value NNT number needed to test POC point-of-care POCT point-of-care testing PPV positive predictive value RADT rapid antigen (...) : D27.505.954.122.085 (antibacterial agents) Study design RCTs, cluster RCTs, non-randomised studies, observational studies Abbreviations: ADR – adverse drug reactions; CRP – C-reactive protein; HRQOL – Health-related quality of life; LTC – long- term care; MeSH – medical subject heading; OOH – out-of-hours; RCT – randomised controlled trial; RTI – respiratory tract infection. CRP POCT to guide antibiotic prescribing in primary care settings for acute respiratory tract infections EUnetHTA Joint Action 3 WP4 34

2019 EUnetHTA

13. Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring. (PubMed)

Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring. Maternal supplementation with long-chain n-3 polyunsaturated fatty acids can have immunologic effects on the developing fetus through several anti-inflammatory pathways. However, there is limited knowledge of the long-term programming effects.In a randomized controlled trial from 1990 with 24 years of follow-up, our aim was to determine whether supplementation with 2.7 g of long-chain n-3 (...) polyunsaturated fatty acids in pregnancy can reduce the risk of asthma in offspring and allergic respiratory disease.The randomized controlled trial included 533 women who were randomly assigned to receive fish oil during the third trimester of pregnancy, olive oil, or no oil in the ratio 2:1:1. The offspring were followed in a mandatory national prescription register, with complete follow-up for prescriptions related to the treatment of asthma and allergic rhinitis as primary outcomes. Furthermore

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2016 Journal of Allergy and Clinical Immunology

14. The Breathing for Life Trial: a randomised controlled trial of fractional exhaled nitric oxide (FENO)-based management of asthma during pregnancy and its impact on perinatal outcomes and infant and childhood respiratory health. (PubMed)

The Breathing for Life Trial: a randomised controlled trial of fractional exhaled nitric oxide (FENO)-based management of asthma during pregnancy and its impact on perinatal outcomes and infant and childhood respiratory health. Asthma exacerbations are common during pregnancy and associated with an increased risk of adverse perinatal outcomes. Adjusting asthma treatment based on airway inflammation rather than symptoms reduces the exacerbation rate by 50 %. The Breathing for Life Trial (BLT (...) outcome, maternal exacerbations requiring medical intervention during pregnancy (both smokers and non-smokers), and hospitalisation and emergency department presentation for wheeze, bronchiolitis or croup in the first 12 months of infancy. Outcome assessment and statistical analysis of the primary outcome will be blinded. To detect a reduction in adverse perinatal outcomes from 35 % to 26 %, 600 pregnant women with asthma per group are required.This trial will provide evidence for the effectiveness

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2016 BMC pregnancy and childbirth

15. Overview of pregnancy complications

/managing-complications-pregnancy-childbirth/en/ It is associated with unprovoked vaginal bleeding with or without supra-pubic pain. Miscarriage occurs in up to one third of pregnancies. Regan L, Rai R. Epidemiology and the medical causes of miscarriage. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14:839-854. http://www.ncbi.nlm.nih.gov/pubmed/11023804?tool=bestpractice.com Moore J, Shillito TJ, Walker JJ. Current issues in management of miscarriage and early pregnancy bleeding. Hosp Med (...) , urticaria, and papules of pregnancy (PUPPS). Sequelae include premature birth and respiratory distress syndrome in pre-term infants. Pre-eclampsia is the occurrence of BP ≥140/90 mmHg in the third trimester, with proteinuria ≥300 mg/24 hours, developing at the same time or shortly thereafter. Eclampsia is the occurrence of seizures without any other cause in a patient with pre-eclampsia. Report of the National High Blood Pressure Education Program: working group on high blood pressure in pregnancy. Am J

2018 BMJ Best Practice

16. Molar pregnancies

). Gestational trophoblastic disease includes tumours of fetal tissues, including hydatidiform moles, arising from placental trophoblasts. Syncytiotrophoblasts secrete human chorionic gonadotrophin and, therefore, this hormonal product is used as a tumour marker for the disease. History and exam presence of risk factors first trimester of pregnancy missed period vaginal bleeding unusually large uterus for gestational age headache and photophobia shortness of breath and respiratory distress severe nausea (...) Molar pregnancies Molar pregnancies - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Molar pregnancies Last reviewed: February 2019 Last updated: March 2018 Summary Chromosomally abnormal pregnancies that have the potential to become malignant. Higher possibility of gestational trophoblastic disease (GTD) for women less than 20 years of age or over 35 years of age, and in those who have experienced GTD in a previous

2018 BMJ Best Practice

17. Overview of pregnancy complications

/managing-complications-pregnancy-childbirth/en/ It is associated with unprovoked vaginal bleeding with or without supra-pubic pain. Miscarriage occurs in up to one third of pregnancies. Regan L, Rai R. Epidemiology and the medical causes of miscarriage. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14:839-854. http://www.ncbi.nlm.nih.gov/pubmed/11023804?tool=bestpractice.com Moore J, Shillito TJ, Walker JJ. Current issues in management of miscarriage and early pregnancy bleeding. Hosp Med (...) , urticaria, and papules of pregnancy (PUPPS). Sequelae include premature birth and respiratory distress syndrome in pre-term infants. Pre-eclampsia is the occurrence of BP ≥140/90 mmHg in the third trimester, with proteinuria ≥300 mg/24 hours, developing at the same time or shortly thereafter. Eclampsia is the occurrence of seizures without any other cause in a patient with pre-eclampsia. Report of the National High Blood Pressure Education Program: working group on high blood pressure in pregnancy. Am J

2018 BMJ Best Practice

18. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. (PubMed)

Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Thyroid dysfunction pre-pregnancy and during pregnancy (both hyper- and hypothyroidism) is associated with increased risk of adverse outcomes for mothers and infants in the short- and long-term. Managing the thyroid dysfunction (e.g. thyroxine for hypothyroidism, or antithyroid medication for hyperthyroidism) may improve outcomes. The best method of screening (...) , placental abruption, respiratory distress syndrome, low birthweight, neonatal intensive care unit admission, or other congenital malformations. The trial did not report on a number of outcomes including adverse effects associated with the intervention. Universal screening versus no screening in pregnancy for hypothyroidismOne trial (21,846 women) compared universal screening with no screening for hypothyroidism. Before 15 + 6 weeks' gestation, women in the universal screening group had their sera tested

2015 Cochrane

19. Impact of the 23-valent pneumococcal polysaccharide vaccination in pregnancy against infant acute lower respiratory infections in the Northern Territory of Australia. (PubMed)

Impact of the 23-valent pneumococcal polysaccharide vaccination in pregnancy against infant acute lower respiratory infections in the Northern Territory of Australia. Indigenous children in Australia's Northern Territory are densely colonised with the pneumococcus within weeks of birth antecedent to a high prevalence of acute lower respiratory infection (ALRI). We assessed the impact of the 23-valent pneumococcal polysaccharide vaccine (23vPPV) in pregnancy against infant ALRI (...) (ascertained from electronic medical records) among infants of pregnancy vaccinees versus infants of mothers not vaccinated in pregnancy (controls) in the first year of life.ALRI hospitalisation incidence was 12.3 per 100 child-years among infants of pregnancy vaccinees compared with 15.8 per 100 child-years among controls (hazard ratio (HR) 0.77, 95%CI 0.29-2.03). ALRI hospitalisations were more common among remote compared to urban infants (27.7 versus 8.6 per 100 child-years). Stratification by dwelling

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2018 Pneumonia (Nathan Qld.)

20. Treating Opioid Use Disorder During Pregnancy: Guideline Supplement

, higher doses may be required to compensate for increased tolerance, and the patient must be monitored for respiratory depression and somnolence. 72 It should be noted that opioid-dependent patients may be hyperalgesic and may require a multimodal approach to pain treatment involving additional pain treatment medications. 72,73 Good communication between the clinical care team and patient is essential throughout pregnancy to devise an appropriate pain management strategy. For patients with a history (...) Health and Addictions, & Perinatal Services BC. A Guideline for the Clinical Management of Opioid Use Disorder—Pregnancy Supplement. Published June 1, 2018. Available at: http://www.bccsu.ca/care-guid- ance-publications/4 AUTHOr S AND CONTr IBUTOr S Guideline Development Committee Ronald Abrahams (Committee Co-chair), MD, CCFP , FCFP , M.S.C.; Clinical Professor, Dept. Family Practice, UBC; Medical Director, Perinatal Addictions, BCWH Andrea Ryan (Committee Co-chair), MD, CCFP , Dip. ISAM; Clinical

2018 British Columbia Perinatal Health Program

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