These guidelines have been replaced by British Guideline on the Management of Asthma. A national clinical guideline. Superseded By 2012 Revision Of 2008 Guideline: British Guideline on the Management of Asthma. Thorax 2008 May; 63(Suppl 4): 1–121.

/pdf/british-guideline-on-the-management-of-asthma-a-national-3q1wreyszl.pdf

British guideline on the management of asthma: A national clinical guideline

Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome).Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation (2). In the United States, the rate of postpartum hemorrhage increased 26% between 1994 and 2006 primarily because of increased rates of atony (3). In contrast, maternal mortality from postpartum obstetric hemorrhage has decreased since the late 1980s and accounted for slightly more than 10% of maternal mortalities (approximately 1.7 deaths per 100,000 live births) in 2009 (2, 4). This observed decrease in mortality is associated with increasing rates of transfusion and peripartum hysterectomy (2-4).The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. In addition, this document will encourage obstetrician-gynecologists and other obstetric care providers to play key roles in implementing standardized bundles of care (eg, policies, guidelines, and algorithms) for the management of postpartum hemorrhage.

ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists

Gender differences in airway behaviour and in the clinical manifestations of airway disease occur throughout the human life span and are related to biological as well as sociocultural factors.1-11 Though they have not escaped recognition, they have received less attention than gender differences in the rates of, for instance, cardiovascular disease, both in terms of research and their implications for clinical practice.4 5 10-12Physiologists have in general paid more attention than clinicians to gender differences in airway behaviour, even though gender differences are an important determinant of the clinical manifestations of airway disease. Similarly, in population based (epidemiological) studies of airway disease, gender is invariably considered a standardising variable rather than a determinant worthy of investigation in its own right.4 However, there have been some notable historical exceptions.

In 1846 John Hutchison,1 a London surgeon, presented a report to the Royal Medical and Chirurgical Society entitled On the capacity of the lungs and the respiratory functions with a view of establishing a precise and easy method of detecting disease by the spirometer . He had developed the spirometer specifically for this research and his study is one of the first, if not the first, population based (epidemiological) study in respiratory health. One of the outcome measurements he used in his research was the “vital capacity” (VC), a term he coined to describe “the greatest voluntary expiration following the deepest inspiration”. His study population comprised over 2000 men drawn from various professions and occupations (including soldiers, sailors, guardsmen, policemen, gentlemen, giants, and dwarfs) and 26 young girls, and he identified height, weight, and age as the important determinants of VC. His epitome (as he called his summary) does not include a comment on whether there were gender differences, probably wisely given the limited number of women …

https://thorax.bmj.com/content/thoraxjnl/54/12/1119.full.pdf

Gender differences in airway behaviour over the human life span

Exacerbations of asthma during pregnancy represent a significant clinical problem and may be related to poor pregnancy outcomes. A systematic review of the literature was conducted for publications related to exacerbations during pregnancy. Four studies with a control group (no asthma) and two groups of women with asthma (exacerbation, no exacerbation) were included in meta-analyses using fixed effects models. During pregnancy, exacerbations of asthma which require medical intervention occur in about 20% of women, with approximately 6% of women being admitted to hospital. Exacerbations during pregnancy occur primarily in the late second trimester; the major triggers are viral infection and non-adherence to inhaled corticosteroid medication. Women who have a severe exacerbation during pregnancy are at a significantly increased risk of having a low birth weight baby compared with women without asthma. No significant associations between exacerbations during pregnancy and preterm delivery or pre-eclampsia were identified. Inhaled corticosteroid use may reduce the risk of exacerbations during pregnancy. Pregnant women may be less likely to receive oral steroids for the emergency management of asthma. The effective management and prevention of asthma exacerbations during pregnancy is important for the health of both the mother and fetus.

https://thorax.bmj.com/content/thoraxjnl/61/2/169.full.pdf

Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes

https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1471-0528.2011.03055.x

A meta-analysis of adverse perinatal outcomes in women with asthma.

BACKGROUND: Acute asthma during pregnancy is potentially dangerous to the fetus. The aim of this study was to investigate the effect of an acute attack of asthma during pregnancy on the course of pregnancy or delivery, or the health of the newborn infant, and to identify undertreatment as a possible cause of the exacerbations. METHODS: Five hundred and four pregnant asthmatic subjects were prospectively followed and treated. The data on 47 patients with an attack of asthma during pregnancy were compared with those of 457 asthmatics with no recorded acute exacerbation and with 237 healthy parturients. RESULTS: Of 504 asthmatics, 177 patients were not initially treated with inhaled corticosteroids. Of these, 17% had an acute attack compared with only 4% of the 257 patients who had been on inhaled anti-inflammatory treatment from the start of pregnancy. There were no differences between the groups as to length of gestation, length of the third stage of labour, or amount of haemorrhage after delivery. No differences were observed between pregnancies with and without an exacerbation with regard to relative birth weight, incidence of malformations, hypoglycaemia, or need for phototherapy for jaundice during the neonatal period. CONCLUSIONS: Patients with inadequate inhaled anti-inflammatory treatment during pregnancy run a higher risk of suffering an acute attack of asthma than those treated with an anti-inflammatory agent. However, if the acute attack of asthma is relatively mild and promptly treated, it does not have a serious effect on the pregnancy, delivery, or the health of the newborn infant.

https://thorax.bmj.com/content/thoraxjnl/51/4/411.full.pdf

Acute asthma during pregnancy

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Acute asthma during pregnancy

Acute asthma during pregnancy