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Pneumonia during pregnancy: has modern technology improved maternal and fetal outcome?
N E Madinger1, J S Greenspoon, A G Ellrodt
1Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
Abstract:
The maternal death rate and rate of preterm delivery associated with pneumonia during pregnancy have not decreased since the introduction of antibiotics four decades ago. We retrospectively reviewed 25 cases of pneumonia during pregnancy; these cases occurred among 32,179 deliveries. Medical complications included: bacteremia, 16%; empyema, 8%; atrial fibrillation, 4%; respiratory failure necessitating mechanical ventilation, 20%. Obstetric complications occurring during the pneumonia episode included: preterm labor, 44%; preterm delivery, 36%. A patient with cystic fibrosis died; one stillbirth and two neonatal deaths occurred. Underlying maternal disease was significantly associated with maternal medical complications (p = 0.023) and preterm delivery (p = 0.012). Significant medical and obstetric complications continue to occur frequently despite modern antimicrobial, tocolytic, and supportive therapy. Underlying maternal disease, including acquired immunodeficiency syndrome and cystic fibrosis, was associated with preterm delivery and neonatal and maternal death.
Insights
Pneumonia during pregnancy remains a significant risk, with high rates of preterm delivery and medical complications. Underlying maternal diseases like cystic fibrosis increase the risk of adverse outcomes, including death.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Pulmonology
Background:
- Pneumonia in pregnancy has seen no decrease in maternal mortality or preterm delivery rates despite advances in antibiotics.
- Significant medical and obstetric complications persist despite modern treatments.
Purpose of the Study:
- To retrospectively review cases of pneumonia during pregnancy.
- To identify associated medical and obstetric complications and risk factors.
Main Methods:
- Retrospective review of 25 pneumonia cases among 32,179 deliveries.
- Analysis of medical complications (bacteremia, empyema, atrial fibrillation, respiratory failure) and obstetric complications (preterm labor, preterm delivery).
Main Results:
- 44% experienced preterm labor and 36% preterm delivery.
- Medical complications included bacteremia (16%) and respiratory failure requiring mechanical ventilation (20%).
- Underlying maternal diseases were significantly associated with medical complications (p=0.023) and preterm delivery (p=0.012).
Conclusions:
- Pneumonia in pregnancy continues to be associated with substantial medical and obstetric morbidity.
- Underlying maternal conditions, such as cystic fibrosis and acquired immunodeficiency syndrome, are linked to increased risks of preterm delivery, neonatal death, and maternal death.