Back ground
Regular and high dose steroid use is needed in medical complications in pregnancy especially with acute exacerbation of severe asthma. Reported obstetrics complications include pre term birth, chorio -amnionitis and rarely uterine rupture in view of its impact on soft tissue degeneration.
uterine scar rupture has been reported as two case reports in women with previous surgical scar as well as de novo presentation in a twin pregnancy requiring early intervention
Case description
a 39 year old woman presented for medical review for concerns of an unplanned pregnancy around 21 weeks of gestation. This was her fourth pregnancy with three previous pregnancies managed with caesarean delivery for large for gestational age weight, likely cephalo- pelvic disproportion and severe uncontrolled asthma.
past medical history revealed childhood asthma with multiple hospitalisations to HDU and other wards but never needing intubation. Her triggers were viral infections, change in weather and pregnancy. she also had nocturnal symptoms and poor sleep with reflux worsened by pregnancy at present.She was managed with high dose steroids up to 90 mg daily to manage her asthma with other regular inhalers and nebulisers. during her last pregnancy she presented with TPL and early scar rupture was noted at the time of surgery. She was advised not to fall pregnant in view of recurrence of scar rupture.
We would like to discuss measures of minimising her risk of scar rupture in the current high risk pregnancy by using alternative agents for steroid sparing effect such as Monteleukast and other biological agents and review current literature of management of severe asthma in pregnancy.
references
1. rupture of an unscarred uterus in a woman on long term steroids for systemic lupus erythematosus
case reports - Obstet Gynecol 2013 August
2. Long term steroid use- A potential risk factor for uterine rupture in pregnancy
G Chir 2019 May
3. ACOG practice bulletin: clinical management guidelines for obstetricians- gynaecologist number 90. Feb 2008
4. asthma in pregnancy : a review
obstet med 2013 June