CO poisoning in pregnant patients

CO poisoning in pregnant women raises a very particular problem: CO poisoning has extremely harmful effects on the fetus, including death, fetal malformations and intellectual retardation. There is no strict parallel between the mother's clinical condition and the severity of fetal poisoning.

From a pathophysiological point of view, three facts must be considered:

- CO diffusion over the placental barrier has the effect of slowing both the uptake and elimination of CO relative to that of the mother67,

- fetal hemoglobin has a greater to CO than adult hemoglobin,

- fetal hypoxia is much more severe than adult hypoxia in CO poisoning which favors CO binding to intracellular hemoproteins.

This explains why the severity of fœtal poisoning cannot be fully appreciated by an assessment of the mother's condition.

We performed a follow-up study over a 7-year period of 90 patients who were pregnant at the time they suffered CO poisoning and were all treated with HBO. Ninety percent of those pregnancies continued and ended with the birth of a normal child. In 5 cases, CO poisoning caused fetal death -- a 4-fold higher incidence than that of spontaneous abortions in our region. However, premature labour, fetal growth retardation and malformation rates were not higher than average.

We therefore recommend treating all pregnant patients suffering from CO poisoning with HBO, irrespective of the mother's condition. The pregnancy should thereafter be considered high risk and needs close monitoring; however, if HBO has been provided, elective termination is no longer recommended.

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