Pneumonia in the Pregnant Patient: A Synopsis

, and , Division of Pulmonary and Critical Care Medicine, Winthrop University Hospital, Mineola, NY

Disclosures

Medscape General Medicine. 1999;1(3) 

In This Article

Abstract and Introduction

Abstract

Pneumonia is the most frequent cause of nonobstetric infection in the pregnant patient. Although infrequently seen in this setting, pneumonia constitutes a serious complication of pregnancy, and is the third most common cause of indirect obstetric death. All diseases in the pregnant host can have an impact on mother and fetus, contributing to morbidity and mortality. A number of physiologic and hormonal changes occur in the pregnant host that specifically predispose to pneumonia. However, the major factor predisposing pregnant women to severe pneumonic infections is an alteration in immune status. These changes occur primarily in cell-mediated immunity, making viral, fungal, and tuberculous infections particularly pathogenic in these women. Series to date have shown that the relative incidence of etiologic agents in the pregnant patient is similar to those seen in the similarly matched nonpregnant patient. However, infection with these pathogens constitutes a greater risk in the pregnant woman because of the physiologic defects in her immune status. Therapy for bacterial pneumonia is first determined by the safety profile of available agents and is aimed at covering for both typical and atypical pathogens. Certain factors especially predispose the pregnant patient to aspiration, including elevated intragastric pressure due to the gravid uterus. Because acid aspiration is an important complication of obstetric anesthesia, the main focus of management is prevention, with some form of chemoprophylaxis often given preoperatively to minimize the risk. This review will discuss the current epidemiology, bacteriology, clinical features, and management of pneumonia in pregnancy.

Introduction

Pneumonia is the most frequent cause of nonobstetric infection[1] in the pregnant patient.Although infrequently seen in this setting, even by the hospital-based pulmonologist, pneumonia constitutes a serious complication of pregnancy, and is the third most frequent cause of indirect obstetric death.[2] The incidence of pneumonia in the pregnant patient is currently rising,[3] reflecting both the declining health of certain segments of the childbearing population and the growing trend in obstetrics for women with serious underlying illnesses to proceed with pregnancy.[2]

Depending on etiology, particular types of pneumonia can have very different implications for the pregnant woman -- especially pneumonia of viral origin. All diseases in the pregnant host can have an impact on mother and fetus, contributing to morbidity and mortality when compared to the nonpregnant host. Additionally, pneumonia in the pregnant patient increases the risk of complicated preterm delivery compared to pregnancies in which infection is absent.

This review summarizes the current epidemiology, bacteriology, clinical features, and management of pneumonia in pregnancy. Throughout, we have emphasized the influence of the gravid state on the natural history of pneumonia, highlighting the differences in disease course when compared to the nonpregnant patient. Particular consideration is given to the differential effect of pneumonia on maternal and fetal outcomes.

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