Clinics in chest medicine
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Symptoms of sleep-disordered breathing are more common in pregnant women compared with nonpregnant women. It is likely that physiology of pregnancy predisposes to the development or worsening of sleep-disordered breathing, but some physiologic changes may also be protective against the development of this disease. Clinical presentation may be less predictive of sleep disordered breathing in pregnancy than in the non-pregnant population; nonetheless, snoring is associated with adverse pregnancy outcomes. Treatment strategies are similar to the nonpregnant population, however, pregnancy-specific scenarios may arise and these subtleties are addressed in this review.
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Clinics in chest medicine · Mar 2011
ReviewManagement principles of the critically ill obstetric patient.
The goals in management of critically ill obstetric patients involve intensive monitoring and physiologic support for patients with life-threatening but potentially reversible conditions. Management principles of the mother should also take the fetus and gestational age into consideration. The most common reasons for intensive care admissions (ICU) in the United States and United Kingdom are hypertensive disorders, sepsis, and hemorrhage. The critically ill obstetric patient poses several challenges to the clinicians involved in her care, because of the anatomic and physiologic changes that take place during pregnancy.
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Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. ⋯ There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.
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Pregnancy may affect the diagnosis, management, and outcome of infiltrative lung disease (ILD). Conversely, ILD may affect pregnancy. ILD may occur as a result of drugs administered commonly or specifically during pregnancy. ⋯ During pregnancy ILD may arise de novo and preexisting ILD may be exacerbated or significantly worsened. Some ILDs generally do not alter the management of pregnancy, labor, or delivery. Preexisting ILD no longer contraindicates pregnancy systematically, but thorough evaluation of ILD before pregnancy is required to identify potential contraindications and adapt monitoring.