Asthma is a chronic airway disorder affecting 22 million Americans. The pathophysiology of asthma is complex, involving inflammation, airway constriction, and airway hyper-responsiveness. Asthma is one of the most common medical conditions affecting pregnant women, complicating approximately 8% of all pregnancies. Asthma may improve or worsen with pregnancy; however, various reports have noted the increased risk for preeclampsia, intrauterine growth restriction, preterm birth, and perinatal mortality in pregnancies complicated by asthma. Asthma is classified by severity of symptoms as well as degree of lung compromise; various ventilatory studies are used for diagnosis and treatment planning. Treatment plans for asthma are aimed primarily at improving oxygenation, preserving lung function, and reducing symptoms and exacerbations. Pharmacologic management usually includes short-acting bronchodilators, long acting inhaled corticosteroids, occasional histamine blockers, or leukotrine modifiers in a step-up approach. During pregnancy, goals of treatment and management of asthma focus on the promotion of fetal oxygenation, prevention of hypoxia, and ongoing assessment of fetal well-being.
The patient was a 34-year old gravida 7 para 3033 who presented at 10 weeks gestation. Her past medical history was significant for “asthma with meds.” Her prior obstetric history was unremarkable; her last delivery was 2 years prior. This pregnancy was uncomplicated until 34 weeks gestation when she presented with a cough and shortness of breath; she was treated with antibiotics. At 38 weeks gestation, the patient was hospitalized after complaints of shortness of breath and a cough for an acute asthma exacerbation with hypoxia. Her treatment plan included short-acting bronchodilator nebulizer treatments and intravenous corticosteroids and antibiotics. She was provided with supplemental oxygen by nasal canula as needed. Fetal monitoring was done intermittently; she had three biophysical profiles during her stay. Fifty hours after admission a fetal demise was suspected during a routine assessment, which was later confirmed by sonogram.
This case highlights the unpredictable course of a pregnancy complicated by asthma and the complexities of management. It is essential that nurses working with pregnant patients perform comprehensive assessments and histories and recognize the implications of identified actual and potential health problems. Nurses using electronic fetal monitoring must be skilled in assessment and interpretation of data and possess the knowledge to utilize additional surveillance measures to assess fetal well-being. Communication and collaboration between members of the interdisciplinary health care team, in a timely effective manner, are essential to promote the best possible outcomes.