1. Dr.Ramadan Elberbash
Dr.AML.M.Alhashimi

2.  Inflammation of the
airways, with an
abnormal accumulation
of eosinophils,
lymphocytes, mast cells,
macrophages, dendritic
cells, and myofibroblasts.
Leads to a reduction in
airway diameter caused
by smooth muscle
contraction, vascular
congestion, bronchial
wall edema and thick
secretions.

3.  Triggers that can cause an
asthma attack vary from
person to person. Common
triggers include
 breathing in cold air,
cold/flu viruses, strenuous
exercise, chemicals,
cigarette smoke, and
allergies to dust, animals,
pollen, or mold. Avoiding
these triggers can reduce
the number of asthma
attacks.

4.  Asthma management during pregnancy should
continue to include the medicines that best control
an individual’s asthma symptoms.
 It is not possible to predict how a woman’s asthma
will act during pregnancy.
 For about one third of women, symptoms will
improve during pregnancy, another one third will
have no change in asthma symptoms, and a final
one third of women will have worsening of
symptoms

5.  The pattern of asthma during one pregnancy will often
define the pattern of asthma during subsequent
pregnancies.
 Asthma attacks seem to be most likely during weeks 17
through 24 of pregnancy possibly because women often
discontinue their asthma medications when they become
pregnant.
 In general asthma is less severe during the last 4 weeks
of pregnancy (37-41weeks).
 There is no association of worsening of asthma with
labour and deliveryA.
 The effects of pregnancy on asthma vary with each
person and it is difficult to predict the course that asthma
will follow in individual women who become pregnant
for the first time.

6.  Studies have shown that
treated asthmatic women
have fewer adverse infant
and maternal outcomes
than those without therapy.
This means that when
asthma is controlled,
pregnant women with
asthma have no more
complications during
pregnancy and givingbirth
than non-asthmatic women.

7. o premature birth,
o low birth weight,
o maternal blood pressure changes
o Preeclampsia
o Need for C/S
o Maternal morbidity
o Maternal mortality

8.  Some studies have suggested an increased risk for birth
defects while others have not.
 In these studies, it is difficult to determine whether the
adverse effects seen were due to the mother’s asthma,
medicines needed to control the asthma, or other factors.
 If a pregnant woman has trouble breathing she will take
in less oxygen. This could lead to a reduced amount of
oxygen getting to the baby. Reduced oxygen for the
developing baby could cause problems in organ
development.
 If there is a risk from asthma itself, it is expected to be
very low. The vast majority of women with asthma have
babies without birth defects.

9.  Yes. Maternal asthma, especially poorly controlled
asthma, is associated with higher rates of pregnancy
complications, such as placental problems, high
blood pressure, premature delivery, higher rates of
cesarean section, and low birth weight.
 It is important for women who are pregnant to
speak with their health care provider about the best
way to treat their asthma during pregnancy. The
benefits of treating asthma during pregnancy
generally outweigh the potential risks of the
medication.

10.  Most asthma medicines have
not been shown to have
harmful effects on the
developing baby.
 Some studies have
suggested an increased risk
for cleft lip with or without
cleft palate (split in the lip or
roof of the mouth) when
corticosteroid pills are taken
during the first trimester.
Based on the available
information, if there is a real
risk for cleft lip and/or palate,
the absolute risk would be
small (less than 1%).

11.  Most asthma medicines
are compatible with
breastfeeding.
 Breastfeeding should be
encouraged as it may
reduce the risk of
childhood asthma,
especially in children
with a family history of
atopy

12.  It is Ok to continue with these
medications if you are already
taking them but normally they are
not started during pregnancy.

13.  Yes, it can be given after the first three months of pregnancy.
 It is recommended for anyone who has identified viral
infections as an asthma trigger.*
 If you have an egg allergy talk to your doctor about this
before taking the flu shot.

14.  The drug treatment
of asthma in
pregnancy is similar
to the treatment of
asthma in non
pregnant women

17.  Oxygen supplementation
(SaO2>95%)( po2>70)
 I.V fluid hydration
 Inhaled sulbutamol(every 20 Min up
to 3 times in first hour)
 Ipratropium bromide (atrovent) in
sever cases
 Systemic corticosteroids either
intravensouly or orally
 I.V Mg sulphate may be beneficial.


18.  Exacerbations of asthma are uncommon during
labour and birth Except in the most severe
cases
 asthma should not preclude a vaginal birth
 Occasionally, women with very severe asthma
may be advised to have an elective delivery
(induction of labour or caesarean section) at a
time when their asthma is well controlled2
 Plan after 37+6 weeks unless there are medical
complications requiring earlier intervention

19. oSymptoms of asthma during labour are generally
controlled with standard asthma therapy
o Inhaled β-agonists do not impair uterine contractions
or delay the onset of labour
o There is no evidence that oxytocin causes
bronchoconstriction2
oErgometrine has been reported to cause
bronchospasm, especially if general anaesthesia is
being used, but this does not appear to be an issue if
Syntometrine is used for prophylaxis of postpartum
bleeding
oRegional anaesthesia is preferred over general
anaesthesia (reduced risk of chest infection)

20.  Postpartum haemorrhage
 Prostaglandin E1 (misoprostol) may be used for the
management of postpartum haemorrhage

 Use intramyometrial PGF2 alpha (dinoprost) with
caution as this may trigger bronchospasm

21.  Women with asthma should be counselled
regarding the importance and safety of continuing
their asthma medications during pregnancy to
ensure good asthma control.
 Women should be advised that poorly controlled
asthma may lead to adverse pregnancy outcomes
(or ‘is associated with increased problems for both
mother and baby’)
 Monitor pregnant women with moderate/severe
asthma closely because poorly controlled asthma
is associated with poorer pregnancy outcomes.
 Acute severe asthma in pregnancy is an
emergency and should be treated vigorously in
hospital.

22.  Give drug therapy for acute asthma as for the non-
pregnant patient including systemic steroids and
magnesium sulphate
 Use inhaled steroids as normal during
pregnancy.
 . Use oral and intravenous theophyllines as
normal during pregnancy.
 Use steroid tablets as normal when
indicated during pregnancy for severe
asthma.

23. oSteroid tablets should never be withheld
because of pregnancy.
o If anaesthesia is required, regional blockade
is preferable to general anaesthesia in women
with asthma.
o Use prostaglandin F2α with extreme caution
in women with asthma because of the risk of
inducing bronchoconstriction.
o Use asthma medications as normal during
lactation in line with manufacturer’s
recommendations.

25. Thank you