Interventional Chest Procedures in Pregnancy

General Management Principles of the Pregnant Woman

“…9 There is also a notable risk of hypoventilation and resultant hypoxemia during bronchoscopic procedures, which is further exacerbated by use of procedural sedation and/or while performing bronchoalveolar lavage. 54 Thus, in a pregnant woman, it is recommended that maternal oxygen saturation should be kept above 95% to prevent fetal desaturation. It is also recommended that lower doses of sedating medications given at longer intervals should be used for pregnant patients during the procedure as the ventilatory response to sedatives may be exaggerated.…”

“…9 To decrease the likelihood of hemodynamic instability due to aortocaval compression by the gravid uterus in women later in pregnancy, it is recommended supine patients should be positioned with a pelvic tilt to the left or the procedure can be performed in sitting position. 54 If necessary, intraprocedural hemostasis may require instillation of epinephrine in addition to other maneuvers such as staying in wedge position and using cold saline. Although epinephrine is noted to have a small risk of decreased uterine flow, significant bleeding may require its use to safely perform the procedure in a pregnant woman.…”

“…Although electrocautery has been safely used during endoscopic retrograde cholangiopancreatography in pregnant women, no published data exist regarding use of these techniques in performing bronchoscopy. 54,57 With regard to fetal monitoring, intraprocedural monitoring of heart rate prior to 28 weeks is considered unreliable and difficult to interpret and prior to 24 weeks is considered unnecessary. 9 Pleural procedures including thoracentesis, chest tube placement, and medical thoracoscopy can be performed during pregnancy.…”

“…With the advent of bedside ultrasonography, the clinician can assess the upward displacement of the diaphragm during pregnancy and safely perform pleural procedures. 54 In management of spontaneous pneumothoraces, the initial management is similar in pregnant and nonpregnant patients, with preferential use of small bore chest tubes placed high in the axilla as compared with large bore chest tubes. 58 The presence of persistent air leak or recurrent pneumothorax may require the patient to undergo video-assisted thoracoscopic surgery with mechanical pleurodesis, which has been safely performed in pregnancy.…”

“…59 Chemical pleurodesis with talc, bleomycin, or tetracyclines should be avoided due to systemic absorption and a potential teratogenic risk. 54 Overall, interventional pulmonary procedures can be safely performed in pregnant women while keeping in mind the maternal anatomic and physiologic changes and relative risks of medications to the mother and the fetus.…”