Pulmonary fibrosis is characterized by scarring of the lung parenchyma resulting in progressive hypoxemia and may be caused by over 200 diseases including acquired (e.g., silica dust), systemic inflammation (e.g., lupus), or genetic (e.g., cystic fibrosis). Pulmonary fibrosis in women of childbearing age may be as high as 1:5000 but during pregnancy more commonly secondary to mixed connective tissue diseases. Decreasing lung volumes as the uterus enlarges during pregnancy may be poorly tolerated in the parturient with pulmonary fibrosis, and women with severe lung disease should be counseled of maternal risks. The anesthetic goal is to decrease oxygen consumption and hyperventilation during labor which can be achieved with epidural analgesia. Avoidance of respiratory acidosis and hypoxemia is important to prevent worsening pulmonary hypertension.
KeywordsPulmonary fibrosis Pregnancy lupus Cystic fibrosis Idiopathic pulmonary fibrosis Interstitial lung disease Pulmonary hypertension
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