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妊娠合并哮喘的产科问题

The obstetric aspects of maternal asthma.

作者信息

Lao Terence T, Annie Hui Shuk-Yi

机构信息

Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.

Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.

出版信息

Best Pract Res Clin Obstet Gynaecol. 2022 Dec;85(Pt A):57-69. doi: 10.1016/j.bpobgyn.2022.08.005. Epub 2022 Aug 28.

Abstract

Asthma is the commonest chronic medical condition encountered in pregnancy. Poor asthma control and exacerbations are frequently encountered due to treatment non-adherence, pregnancy-related aggravating factors such as increased susceptibility to viral infections, and comorbidities that are commonly associated. Asthma-related inflammatory reactions and placental effects, the effect of medications, and respiratory symptoms and hypoxia are probably to interact to result in an increased adverse obstetric outcomes including miscarriage, foetal congenital anomalies, pregnancy hypertensive disorders, gestational diabetes, preterm labour and birth, antepartum haemorrhage, low birthweight and foetal growth restriction (FGR), caesarean delivery, postpartum haemorrhage (PPH), maternal intensive care admission, and even mortality, while the offspring also has increased long-term morbidity. Interdisciplinary management with frequent assessment by symptoms, spirometry, and biomarkers, together with removal of risk factors such as smoking and appropriate instigation of treatment including short courses of systemic corticosteroid, could ensure optimal and tailored treatment to control symptoms, prevent exacerbations, and ultimately enhancing maternal and perinatal outcomes.

摘要

哮喘是孕期最常见的慢性疾病。由于治疗依从性差、与妊娠相关的加重因素(如对病毒感染易感性增加)以及常见的合并症,哮喘控制不佳和急性发作屡见不鲜。哮喘相关的炎症反应和胎盘效应、药物的作用以及呼吸道症状和缺氧可能相互作用,导致不良产科结局增加,包括流产、胎儿先天性异常、妊娠高血压疾病、妊娠期糖尿病、早产和分娩、产前出血、低出生体重和胎儿生长受限(FGR)、剖宫产、产后出血(PPH)、产妇入住重症监护病房,甚至死亡,而子代的远期发病率也会增加。通过症状、肺功能测定和生物标志物进行频繁评估的多学科管理,以及消除吸烟等危险因素并适当启动包括短期全身用糖皮质激素在内的治疗,可确保进行优化和个性化治疗,以控制症状、预防急性发作,并最终改善孕产妇和围产儿结局。

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