But this also conflicts with what I just found.. You may want to read this one through thoroughly.
Management of Pneumonia in Pregnancy
Many women use their women's healthcare provider as their primary care provider. As a result, these clinicians must familiarize themselves with how common medical problems affect their patients when they are pregnant and make any necessary adjustments in clinical management. Cheney gave an overview of the management of some common respiratory illnesses that may affect pregnant patients.
Pneumonia is the leading cause of death during pregnancy from nonobstetric causes. With the advent of antibiotic therapy, maternal mortality had been decreasing, but recently there has been an increase in cases due to:
- Drug use; and
- Increase in maternal age during pregnancy.
When symptoms indicate the possibility of pneumonia, clinicians need to do a thorough history and physical examination to rule out other causes of respiratory complaints such as:
- Pulmonary emboli;
- Congestive heart failure;
- Tuberculosis; and
Causes of pneumonia include Streptococcus pneumoniae, Haemophilus pneumoniae,
and Klebsiella pneumoniae.
Atypical organisms to consider include Mycoplasma, Legionella,
Viral causes may include varicella, influenza,
and Pneumocystis carinii
secondary to HIV.
The diagnostic evaluation may include:
- Complete blood cell count;
- Sputum Gram stain/culture;
- Blood cultures;
- Serum cold agglutinins; and
- Titers for suspected pathogens.
In addition, imaging studies such as a chest x-ray may be needed to make the diagnosis. When considering the use of x-ray, the effect of radiation on a developing fetus is always a major concern. Studies have shown developmental anomalies and growth retardation with radiation thresholds >/= 5 rad. A typical chest x-ray delivers a dose between 30 and 100 mrad and may be used safely in pregnancy, if warranted. All pregnant women should be appropriately shielded with a lead apron during the procedure.
Choice of therapy for pneumonia will be guided by the clinical diagnosis. If antibiotic therapy is necessary, safe choices in pregnancy include:
- Azithromycin; and
Drugs that should be avoided in pregnancy include clarithromycin, which has been associated with teratogenetic effects in animal studies, and the quinolone family, which have been associated with adverse effects on bone development in animal studies.
The only drug available to treat patients who are diagnosed with Pneumocystis carinii
pneumonia, an opportunistic AIDS-related infection, is trimethoprim-sulfamethoxazole (Bactrim, Septra
). It is a folic acid antagonist, so folate supplementation must be given.
Additional supportive measures may include:
- Oxygen therapy;
- Beta agonists;
- Postural drainage; and
Pregnant women have a 20% increase in oxygen consumption during pregnancy, and, along with a decrease in functional residual capacity seen with pneumonia, a woman's ability to tolerate even limited periods of hypoxia is limited. Cheney pointed out that it is critical that clinicians diagnose pneumonia and its causes early and treat with the appropriate therapy in order to limit risks to the mother and the fetus.
From this website: