Silverman R K, Montano J
Department of Obstetrics and Gynecology, State University of New York, Syracuse 13210, USA.
J Reprod Med. 1997 May;42(5):309-11.
Carbon monoxide poisoning in pregnancy is a relatively rare occurrence, with potentially serious complications for both mother and fetus. Controversy regarding treatment during pregnancy exists primarily due to the concern for oxygen toxicity in the fetus. However, rapid oxygen dissociation and prolonged clearance of carbon monoxide in the fetal circulation emphasize the importance of adhering to aggressive treatment protocols.
A 22-year-old employee at an office undergoing repairs on the heating and ventilation systems presented with neurologic symptoms, tachycardia, tachypnea, signs of preterm labor and a carboxyhemoglobin level that was mildly elevated. Fetal monitoring demonstrated a reactive nonstress test with mild to moderate repetitive variable decelerations. The patient underwent hyperbaric oxygen treatment, with complete resolution of her neurologic symptoms, tachycardia and tachypnea as well as fetal variable decelerations. She was additionally treated with intravenous magnesium sulfate tocolysis, with cessation of contractions. The patient subsequently delivered at term; the viable infant had no sequelae of in utero carbon monoxide poisoning.
This case supports previously published recommendations for treating acute carbon monoxide poisoning during pregnancy with hyperbaric oxygen. As more cases are gathered, a more widely accepted set of standards can be established.
孕期一氧化碳中毒相对少见，但对母亲和胎儿都可能产生严重并发症。孕期治疗存在争议主要是因为担心胎儿氧中毒。然而，胎儿循环中一氧化碳的快速氧解离和清除时间延长强调了遵循积极治疗方案的重要性。
一名22岁在进行供暖和通风系统维修的办公室工作的员工，出现神经症状、心动过速、呼吸急促、早产迹象以及碳氧血红蛋白水平轻度升高。胎儿监护显示无应激试验反应型，伴有轻度至中度重复性可变减速。患者接受了高压氧治疗，其神经症状、心动过速和呼吸急促以及胎儿可变减速完全缓解。她还接受了静脉注射硫酸镁抑制宫缩治疗，宫缩停止。患者随后足月分娩；存活婴儿无宫内一氧化碳中毒后遗症。
该病例支持先前发表的关于孕期急性一氧化碳中毒采用高压氧治疗的建议。随着更多病例的收集，可以建立一套更广泛接受的标准。
