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

Effect of Pneumonia on Maternal Outcomes

Pneumonia that occurs during pregnancy clearly carries an increased risk of adverse outcome when compared to pneumonia in nonpregnant women (Table I).[2,3,9,10] (The variation in reported obstetric complications observed in this table can be explained by two factors. First, follow-up was largely incomplete in earlier studies, leading to underestimation of prematurity. Second, the change in maternal host from 1965 to 1989 is considerable -- comorbidities are now more frequently seen and managed during the course of a pregnancy. AIDS, for example, was a newcomer to the maternal host, and the ability to more successfully manage chronic illness prior to pregnancy has allowed a population of women to become pregnant for the first time. Collectively, these factors conspire to increase the obstetric risks from the outset of pregnancy, regardless of the presence of pneumonia. )

For comparative purposes, the ATS-CAP 1993 guidelines[11] report pneumonia as the sixth leading cause of death and the number one cause of death from infectious diseases among the general population. In the outpatient setting the mortality rate of pneumonia remains low (1%-5%), but once the patient is hospitalized the mortality increases to as much as 25%, particularly if that patient is admitted to the ICU.

Although pneumonia is an uncommon cause of death among all pregnant women, the mortality rate can still be quite high among those who do develop disease in pregnancy. In the pre-antibiotic era, the maternal death rate was observed to be as high as 32% in all such cases.[9] However, with the advent of antibiotics, there was a reduction in maternal deaths due to pneumonia during pregnancy. This trend is reflected by findings in Hopwood's[8] series, which showed that mortality attributable to pneumonia in pregnancy declined to 8.6%. Furthermore, Benedetti and colleagues[9] noted no maternal mortality in their sample of pregnant women with pneumonia, possibly because all the patients in this series were treated within 7 days of symptom onset and none were bacteremic. The severity of illness in this series was also low, as estimated by blood gas measurement (Table III).

Madinger's series reports contrary findings. Of the 25 patients studied, 40% had multiple complications associated with development of pneumonia during pregnancy: 5 required intubation, 2 developed empyema, 1 had pneumothorax, 1 had pericardial tamponade, and 1 had atrial fibrillation.[10] Only one maternal death resulted, occurring in a patient with cystic fibrosis who had been previously advised to avoid pregnancy. On a positive note, the relatively low mortality in this severely ill population reflects the efficacy of current therapeutic modalities and the general good health of women of childbearing age. This conclusion is also borne out in other series,[3] although viral lung infection and opportunistic lung infection still carry a substantial maternal mortality and morbidity.[14,15,16,17,18]

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