Abstract

Background: Respiratory diseases in pregnancy gained much attention in the background of H1N1 influenza which has emerged as a killer of pregnant women. According to the confidential review of maternal deaths, 2006-09 Kerala, respiratory diseases form the sixth most common cause of maternal death.

Aim: To analyze then maternal and perinatal outcome of acute lower respiratory tract infection in the third trimester of pregnancy among antenatal women attending a tertiary care hospital of South Kerala

Method: Prospective Cohort Study

Study Setting: Conducted among antenatal women attending SAT hospital Trivandrum. 254 cases diagnosed to have acute lower respiratory tract infection were consecutively recruited as study cohort and an equal number of unexposed groups of similar gestational age as control.

Both groups followed up to find out the fetomaternal outcome.

Results: History of bronchial asthma (p<0.001), passive smoking (p=0.001) and recent history of contact with respiratory infection/ exanthematous fever (p<0.001) are significantly associated with acute lower respiratory tract infection in third trimester of pregnancy. There is increased rate of cesarean section (16.9% vs 26.8%), intrapartum maternal pyrexia (14.6% vs 0.4%), prolonged duration of hospital stay (58.7% vs 17.3%). Fetal distress (25.2% vs 11.4%), MSAF (14.2% vs 7.5%), RDSAB (38.6% vs 13%), increased rate of IBN admission (38.2% vs 14.6%) and increased requirement of ventilator support for babies (7.9% vs 2.4%).

Conclusion: The significant adverse outcomes of acute LRTI in third trimester of pregnancy are increased CS rate, intrapartum maternal pyrexia, MSAF, foetal distress, RDSAB and increased IBN admission. Prompt diagnosis and adequate treatment of acute LRTI including early initiation of antiviral therapy in indicated cases is needed to avoid these adverse outcomes.

Keywords: Acute lower respiratory tract infection, Maternal outcome, perinatal outcome, third trimester of pregnancy, CURB’S Score.