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The effects of cigarette smoking on pulmonary function tests during pregnancy
CARDIOVASCULAR, HEMATOLOGIC, AND PULMONARY
Impact of menses on sleep (mean score) Impact of menses on mood (mean score) Impact of menses on over-all quality of life (mean score)
Controls
vWd pts
P value
1.3 6 2.3
3.6 6 3.1
,.0001
3.5 6 2.8
5.6 6 3.3
,.0001
1.7 6 1.8
4.2 6 3.1
,.0001
Conclusions: vWd markedly diminishes the quality of life during menses. This observation warrants efforts to reduce the attendant morbidities of vWd in menstruating women.
Use of adenosine for pharmacological cardioversion of SVT in pregnancy Nahida Chakhtoura, MD, Roberto Angioli, MD, Salih Yasin, MD University of Miami School of Medicine, Miami, Florida Objective: To evaluate the success and safety of adenosine use in treating maternal supraventricular tachycardia (SVT) in pregnancy. Methods: Hemodynamically stable pregnant women diagnosed with supraventricular tachycardia admitted to Jackson Memorial hospital from 1990 to 1995 and treated with adenosine were included in the study. Adenosine was given intravenously with an initial dose of 6 mg, followed by two 12 mg doses as needed. Mothers and fetuses were followed prospectively to assess short-term and long-term effects of the treatment. Results: A total of four pregnant patients were treated with adenosine for medical cardioversion of SVT. All patients were hemodynamically stable upon arrival to the maternity ward and were successfully treated with adenosine. Both mothers and fetuses were monitored during treatment. Adenosine successfully converted the SVT to sinus rhythm, in all four patients. One patient was treated successfully twice, at 15 weeks and subsequently at 24 weeks. No complications occurred to either the mothers or the fetuses during the treatment. Five and ten minute APGAR scores at birth were greater than seven. Mothers and babies were followed from 1 month to 5 years after treatment and no contributory deleterious effects have been found. One patient was lost to follow-up. Conclusion: Our four patient cases, added to the limited published cases in the literature, support adenosine’s safety and efficacy for the medical treatment of supraventricular tachycardia in the hemodynamically stable pregnant woman. 154
The effects of cigarette smoking on pulmonary function tests during pregnancy Robert K. Silverman, MD, Laura France, MD Objective: The objective of this study was to determine what changes occur in pulmonary function testing in pregnant women who smoke versus nonsmokers. Methods: This was a prospective study. Pregnant women were recruited in all trimesters of pregnancy. A total of 34 women (15 smokers, 19 nonsmokers) were recruited. Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEVI), the ratio of FEVI to FVC, and maximum voluntary ventilation (MVV) were obtained. Results: FVC
FEVI
FEVI/FVC
MVV
x 6 SD 3.56 6 .80 2.31 6 .81 0.65 6 .17 55.55 6 14.04 nonsmokers x 6 SD 3.45 6 .65 1.96 6 .87 0.56 6 .19 57.80 6 20.18 smokers P value NS NS NS ,.01 Residual 0.73 0.84 0.18 16.74 variance F statistic 0.12 1.22 0.36 7.07
Conclusions: This study confirms other studies that have seen no significant changes in FVC, FEVI, FEVI/FVC in pregnant smokers and nonsmokers. A significant worsening in MVV was seen in pregnant women who smoke. The pathophysiologic impact of this effect is unclear. However, since MVV is a measure of the bellows action of the chest, this may lead to a decrease in oxygenation during the active phase and the second stage of labor. This may lead to more abnormal fetal monitoring strips and possibly lower Apgar scores. Further investigation will be necessary to clarify the effects on pregnancy of lower MVV in patients who smoke.
Normative oxygen saturation values for pregnant women at sea level Spencer Richlin, MD, William Cusick, MD, Christopher Sullivan, MD, Gary Dildy, MD, Michael Belfort, MD The Department of Obstetrics and Gynecology, The Stamford Hospital, Stamford, Connecticut Objective: To develop normative ranges of maternal arterial oxygen saturation (SpO2) for women residing at sea level throughout gestation and postpartum. Materials and Methods: Healthy, nonsmoking, non-laboring pregnant women, with no obstetrical risk factors, were recruited into this longitudinal study performed at The Stamford Hospital (elevation sea level). Maternal SpO2 was meaPrim Care Update Ob/Gyns
Impact of menses on sleep (mean score) Impact of menses on mood (mean score) Impact of menses on over-all quality of life (mean score)
Controls
vWd pts
P value
1.3 6 2.3
3.6 6 3.1
,.0001
3.5 6 2.8
5.6 6 3.3
,.0001
1.7 6 1.8
4.2 6 3.1
,.0001
Conclusions: vWd markedly diminishes the quality of life during menses. This observation warrants efforts to reduce the attendant morbidities of vWd in menstruating women.
Use of adenosine for pharmacological cardioversion of SVT in pregnancy Nahida Chakhtoura, MD, Roberto Angioli, MD, Salih Yasin, MD University of Miami School of Medicine, Miami, Florida Objective: To evaluate the success and safety of adenosine use in treating maternal supraventricular tachycardia (SVT) in pregnancy. Methods: Hemodynamically stable pregnant women diagnosed with supraventricular tachycardia admitted to Jackson Memorial hospital from 1990 to 1995 and treated with adenosine were included in the study. Adenosine was given intravenously with an initial dose of 6 mg, followed by two 12 mg doses as needed. Mothers and fetuses were followed prospectively to assess short-term and long-term effects of the treatment. Results: A total of four pregnant patients were treated with adenosine for medical cardioversion of SVT. All patients were hemodynamically stable upon arrival to the maternity ward and were successfully treated with adenosine. Both mothers and fetuses were monitored during treatment. Adenosine successfully converted the SVT to sinus rhythm, in all four patients. One patient was treated successfully twice, at 15 weeks and subsequently at 24 weeks. No complications occurred to either the mothers or the fetuses during the treatment. Five and ten minute APGAR scores at birth were greater than seven. Mothers and babies were followed from 1 month to 5 years after treatment and no contributory deleterious effects have been found. One patient was lost to follow-up. Conclusion: Our four patient cases, added to the limited published cases in the literature, support adenosine’s safety and efficacy for the medical treatment of supraventricular tachycardia in the hemodynamically stable pregnant woman. 154
The effects of cigarette smoking on pulmonary function tests during pregnancy Robert K. Silverman, MD, Laura France, MD Objective: The objective of this study was to determine what changes occur in pulmonary function testing in pregnant women who smoke versus nonsmokers. Methods: This was a prospective study. Pregnant women were recruited in all trimesters of pregnancy. A total of 34 women (15 smokers, 19 nonsmokers) were recruited. Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEVI), the ratio of FEVI to FVC, and maximum voluntary ventilation (MVV) were obtained. Results: FVC
FEVI
FEVI/FVC
MVV
x 6 SD 3.56 6 .80 2.31 6 .81 0.65 6 .17 55.55 6 14.04 nonsmokers x 6 SD 3.45 6 .65 1.96 6 .87 0.56 6 .19 57.80 6 20.18 smokers P value NS NS NS ,.01 Residual 0.73 0.84 0.18 16.74 variance F statistic 0.12 1.22 0.36 7.07
Conclusions: This study confirms other studies that have seen no significant changes in FVC, FEVI, FEVI/FVC in pregnant smokers and nonsmokers. A significant worsening in MVV was seen in pregnant women who smoke. The pathophysiologic impact of this effect is unclear. However, since MVV is a measure of the bellows action of the chest, this may lead to a decrease in oxygenation during the active phase and the second stage of labor. This may lead to more abnormal fetal monitoring strips and possibly lower Apgar scores. Further investigation will be necessary to clarify the effects on pregnancy of lower MVV in patients who smoke.
Normative oxygen saturation values for pregnant women at sea level Spencer Richlin, MD, William Cusick, MD, Christopher Sullivan, MD, Gary Dildy, MD, Michael Belfort, MD The Department of Obstetrics and Gynecology, The Stamford Hospital, Stamford, Connecticut Objective: To develop normative ranges of maternal arterial oxygen saturation (SpO2) for women residing at sea level throughout gestation and postpartum. Materials and Methods: Healthy, nonsmoking, non-laboring pregnant women, with no obstetrical risk factors, were recruited into this longitudinal study performed at The Stamford Hospital (elevation sea level). Maternal SpO2 was meaPrim Care Update Ob/Gyns