Hyperbaric Treatment in the Pregnant Patient

N. 2 - Giugno 2007 f 61
Medicina Subacquea e Iperbarica
Hyperbaric Treatment in the Pregnant Patient
with Acute Carbon Monoxide Intoxication:
Outcome and Follow
up Neonatal and Pediatric
G. Vezzani, A. Pizzola, L. Cantadori, M. Mordacci, A. Nicoloupolou, D. Manelli, M. Valesi°
AUSL Parma, D.E.U.U.O. Anestesia-Rianimazione, Terapia Iperbarica e Antalgica P.O. Vaio-Fidenza
° Clinical Manager Centro Iperbarico Ospedale Fidenza, Parma, Italy
RIASSUNTO
Sono state trattate in camera iperbarica a 2.5 ATA per
80’, 35 pazienti gravide in diverse età gestazionali e appartenenti a diversi gradi di gravità di intossicazione
come descritto in Koren et al 1991. Alla nascita è stato
valutato l’apgar e quindi controllati vari parametri neurofisiologici: il primo sorriso, mantenere la posizione
seduta senza supporto, camminare senza aiuto, la prima
parola emessa. Si è constatato un ritardo nello sviluppo
neuropsicologico nelle gravide intossicate al primo trimestre di gravidanza, indipendentemente dal valore di
HbCO materno e dal tempo di esposizione. A 20 mesi
di osservazione tutti i parametri rientravano nella
norma.
Introduction
The pregnant with Carbon Monoxide (CO) intoxication
poses special problems in treatment. It is essential to explain that there may be negative consequences on the
continuation of pregnancy or on normal fetal development.
METHODS: we admitted 35 patients as follows: 1st trimester (1T) N=18, (2T) N=9, (3T) N=8. All patients had
hyperbaric treatment at 2.5 ATA for 80 minutes. We
stratified patients in 5 degrees of severity based upon
their consciousness level as in Koren (1991). For every
neonate we calculated the Apgar index and follow up of
Indirizzo per la richiesta di estratti:
G. Vezzani
Ospedale di Vaio-Fidenza ASL Parma
Servizio di Anestesia,
Rianimazione e Terapia Iperbarica
Via Don E. Tincati, 5 - 43036 Fidenza (Pr), Italy
Hyperbaric Treatment in the Pregnant Patient
Simsi 2 07 imp.indd 61
psychophysic development, we calculated: a)the first
smile (FS); b)maintaining the sitting position (SP) without support; c)independent walking (IW); d)the first
word (FW).
Results
The severity of the patients was equally distributed among
the three trimesters. Two spontaneous abortions in 2nd
and 3rd week pregnancy, and an elective abortion on the
6th week. We were able to follow 24 neonates distributed
as such: 11 from mothers with CO intoxication during 1T,
6 during the 2T, 7 during 3T. No correlation was found
between neonatal outcome and maternal COHb level. It
can be easily noticed that there is a significant delay in
psychophysic development of the neonates intoxicated
during the 1T, as compared to those intoxicated during
the 2T and 3T; p<0.01(Kruskal-Wallis test).
Discussion
We believe it is not necessary that there be a loss of consciousness or a high level of severity to induce embryonal
or fetal brain problems. In our cases, in 11 pregnant patients in the 1T, we had two spontaneous abortions, although the mothers were classified as second degree of
severity.
Conclusion
We suggest that only parameter which can be correlated
with intrauterine death or with a significant delay in psychophysical development, is gestational age.
Vezzani, Pizzola, Cantadori, Mordacci, Nicoloupolou, Manelli, Valesi
09/01/2008 11.46.29