Should hyperbaric oxygen be used to treat the pregnant patient for acute carbon monoxide poisoning? A case report and literature review

Article Abstract:

A 17-year-old pregnant female was brought to the hospital after sustaining acute accidental carbon monoxide poisoning while riding in a car. When first seen, the patient was not mentally alert, but could be aroused. Examination of her fetus revealed acute fetal oxygen deprivation (hypoxia). Because of the patient's depressed mental state and the fetal hypoxia, the patient was placed in a hyperbaric oxygen chamber. She was treated with 100 percent oxygen at 2.4-fold increased air pressure (2.4 atmospheres). Within 10 minutes, the fetal heart rate decreased to normal levels and the patient's complaints of headache, chest pain and uterine contractions were gone. She was removed from the hyperbaric chamber after 90 minutes, kept in the hospital overnight and released the next day. The treatment was based on the understanding that hemoglobin, the oxygen-carrying pigment of the blood, combines 200 times more strongly with carbon monoxide than with oxygen. This competition between carbon monoxide and oxygen greatly favors the attachment of carbon monoxide to hemoglobin and results in a dramatic reduction of oxygen availability at the tissue level. A fetus is more seriously affected by problems of carbon monoxide poisoning. Hyperbaric oxygen is an effective treatment because oxygen is able to saturate the blood plasma and be carried by the plasma directly to body tissues. The high level of oxygen also tends to wash carbon monoxide out of the tissues and decreases the half-life of the combined oxygen-hemoglobin complex (it is removed much more rapidly) from over five hours to approximately 23 minutes. The use of hyperbaric oxygen during pregnancy is controversial and has been carried out infrequently. In this case, the dangerously high blood level of carbon monoxide in the patient's blood with her obvious neurologic involvement and the diagnosis of fetal distress strongly supported the use of hyperbaric oxygen, which was probably beneficial.

Usage, Patient outcomes, Mortality, Fetus, Physiological aspects, Carbon monoxide, Hyperbaric oxygenation

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Home uterine activity monitoring for preterm labor: review article

Article Abstract:

Home uterine activity monitoring (HUAM) is used for early detection of preterm labor in women with a high-risk pregnancy. Preterm birth is a major cause of complications and death among newborns. A research study reviewed articles published in the medical literature after 1983 that examined the effectiveness of HUAM. Several research studies have found that HUAM reduces the incidence of preterm birth, low birth weight and newborn complications. These studies may have had several limitations that affected their results. Women with a high-risk pregnancy may have a better outcome with a combination of HUAM and frequent telephone contact with health care providers. No adverse effects or complications have occurred in women who have had HUAM. Women who have HUAM may see their physician more often to have abnormal tracings evaluated. The effectiveness of HUAM in reducing treatment costs is uncertain.

Prevention, Birth weight, Low, Low birth weight, Premature labor, Uterus, Uterine contractions

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Prenatal care, pregnancies complicated by diabetes

Article Abstract:

Pregnant women who are suffering from diabetes may have a higher risk of developing complications during their pregnancy than other women. These complications may affect their health or the health of their unborn child significantly. Some women may be suffering from diabetes before their pregnancy, while others may develop the disease during pregnancy. Diabetic women who are considering pregnancy should receive prepregnancy counseling. All pregnant women should receive prenatal care beginning early in their pregnancy. This care should include screening for gestational diabetes during the 24th to 28th week of pregnancy. Women from certain ethnic groups or minorities are less likely to receive adequate prenatal care and may have a higher risk of developing diabetes than other women. The incidence of diabetes is higher among older women than younger women.

Diabetes in pregnancy, Gestational diabetes

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