///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-05:00

Cystic Fibrosis and Morbid Obesity in a Parturient

Abstract Number: 217
Abstract Type: Case Report/Case Series

Reine A Zbeidy MD1 ; Donald H Penning MD2; Jayanthie S Ranasinghe MD3; Deborah Brauer MD4; Takeko Toyama MD5

Introduction: More women with cystic fibrosis now reach reproductive age. Although women with cystic fibrosis have reduced fertility many of them can become mothers.

Case report: We describe a 36 year-old, morbidly obese (BMI=58), multigravida (G5P4004), with cystic fibrosis. She had chronic pseudomonas infections, severe lung disease (FEV1=35% predicted), and required multiple hospitalizations during pregnancy. She was admitted for deteriorating lung function, intravenous antibiotics and intensive chest physiotherapy. An echocardiogram showed no evidence of pulmonary hypertension. Baseline arterial blood gases showed CO2 retention (48mmHg) and respiratory acidosis (ph 7.35). She was dependent on home oxygen, and could mobilize only a short distance at home. She had four previous normal vaginal deliveries. Labor was induced at 35 weeks. Monitoring consisted of pulse oximetry, ECG, and direct intra-arterial blood pressure measurement. Two 16 gauge peripheral cannulas were sited intravenously. An intrathecal catheter (Arrow 19G) was placed at L3/L4 using a midline approach. The initial subarachnoid dose was isobaric bupivacaine 0.25%, 0.5ml plus fentanyl 15 micrograms. We achieved bilateral loss of temperature sensation to T9 and pinprick to T11. A continuous spinal infusion of 1.5ml/hr of bupivacaine 0.125% and fentanyl 2 micrograms/ml resulted in excellent analgesia throughout her labor. The patient had a planned forceps-assisted vaginal delivery of a healthy male infant after 12-hours of labor. Postpartum, she was transferred to the ICU for monitoring. She was discharged home after four days. At 3-months follow up, the infant was in good health and the mother had returned to her baseline condition.

Discussion: Morbid obesity is uncommon in cystic fibrosis. This added to her anesthetic risk in a unique way. We selected a regional technique, but opted for an intrathecal catheter technique to allow for a secure mode of analgesia that we could titrate. The literature identifies risk factors relevant to cystic fibrosis and pregnancy. A reduction in FEV1, infection with burkholderia cepacia or pulmonary hypertension was associated with a poorer outcome. Of these, our patients FEV1 was significantly reduced but the additive effect of severe obesity is unknown but likely significant.

References:

1) Assimina Galli-Tsinopoulou, Sanda Nousia-Arvanitakis. Successful pregnancy and delivery in a young woman with cystic fibrosis and gestational diabetes. Journal of Cystic Fibrosis 1 (2002) 39-41.

2) Marie Johannesson. Effects of pregnancy on health: certain aspects of importance for women with cystic fibrosis. Journal of cystic fibrosis 1 (2002) 9-12.

SOAP 2009