Arumugam, M C (2017) Assessment of Pulmonary Function by Spirometry in Antenatal Cases. Masters thesis, Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Madhuranthagam.
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Abstract
INTRODUCTION : Pregnancy is the distinctive nature of a particular order in which related things follow each other of effective physiological changes that a marked effect on various organs function and is associated with multiple changes in respiratory system anatomy and physiology. Three important changes in the organization of the thorax that occur during the period of pregnancy were an expansion in the width of the lower-level of chest wall (anteroposterior and the transverse diameters are increased) ; raise of the diaphragm (a cephalad displacement of approximately 4 cm to 5 cm) and a 50% broadening of the costal angle. These alterations attain the maximum around the 37th week of pregnancy and become normal within 6 months after delivery. Pulmonary function is disturbed by changes in the airway, thoracic cage, and respiratory drive. And also capillary engorgement in the entire respiratory tract leads to mucosal edema and hyperemia. Multiple biochemical changes like increase in progesterone, estrogen, prostaglandins, corticosteroid and cyclic nucleotide levels occur simultaneously during the period of pregnancy. AIM AND OBJECTIVES : AIM : To determine the effect of pregnancy on pulmonary function parameters in antenatal cases attending Karpaga Vinayaga Institute Medical Sciences and Research Centre, Kancheepuram District. OBJECTIVES : 1. To establish the values of Forced Vital Capacity (FVC) in Pregnancy. 2. To establish the values of Forced Expiratory Volume (FEV1) in Pregnancy. 3. To verify the difference in FEV1/FVC during Pregnancy. 4. To evaluate the values Peak Expiratory Flow Rate (PEFR) during Pregnancy. 5. To assess the effect of gestational age (1st , 2nd and 3rd trimester) on these parameters. MATERIALS AND METHODS : Study Design : Observational Study. Study Setting : Antenatal women attending the Obstetric and Gynecology Department of Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chinnakaolambakkam, Kancheepuram district. Study Period : April 2015 to January 2016. Population and Sampling : The antenatal mothers visiting OBG department were taken for the study after getting informed consent, the consent being explained in their own language. The subjects were grouped into three: Pregnant subjects of first trimester (up to12 weeks), second trimester (13 weeks to 28 weeks) and third trimester (29 weeks to up to birth) gestational period. Totally 90 samples, (i.e) 30 subjects in each group were selected for this study by purposive sampling technique. Inclusion Criteria : 1. Confirmed pregnant women who were willing to participate 2. Ability to demonstrate sufficient proficiency in carrying out the tests needed to assess ventilatory function. Exclusion Criteria : Patients with the following were excluded: Pre-existing cardio-respiratory diseases like asthma, Chronic Obstructive Airway Disease (COPD), Congestive Cardiac Failure (CCF). Presence of spinal deformities (scoliosis, kyphoscoliosis) Upper and lower respiratory tract infections. Medications that alter lung function (e.g. bronchodilators and constrictors). Acute malaria in pregnancy. Pre-eclampsia. Diabetes in pregnancy. Other pregnancy complications (threatened abortion, antepartum hemorrhage etc) We have used computer-based spirometry, Medicaid spiro excel in performing pulmonary function test for the study participants in this study. METHODOLOGY : The subjects considered for this study are with Hemoglobin more than 10 gm%. All the subjects were called for spirometric tracings, 3 to 4 hrs after meal, in the post absorption stage in order to keep uniform conditions for recording the tests. All the subjects were given instructions and with regard to the performance of the tests. The tracings in the spirograph were taken after being fully satisfied. Two to three tracings were taken out of which the best is taken as the final reading. RESULTS : In this study, 90 subjects were selected considering 30 equal samples in each group. Their age ranged from 18 years to 34 years overall. Table 1 describes the distribution of age among the three trimesters 66 subjects were in the age group of 21 years to 30 years. There is no significant difference between the groups by chi-square test (p = 0.8). SUMMARY AND CONCLUSION : The present study proved that the respiratory parameters are significantly altered during pregnancy. The increased FVC, PEFR, FEV1, and FEV1/FVC ratio is a strong indication that pregnancy causes physiological adaptation in the lungs. Hormones determine changes in smooth muscle tone and possibly connective tissue - elastance might occur during pregnancy which probably alters the mechanical properties of the respiratory system. FVC increases significantly during the second trimester of gestation and throughout pregnancy. FEV1/FVC% is significantly higher in Second and the third trimester multiparous than primigravida women, suggesting that changes in FVC occurring during pregnancy persist postpartum. PEFR increases significantly during healthy pregnancies and should be interpreted cautiously in pregnant women with impaired lung function With the combination of increased oxygen consumption and the decreased expiratory reserve volume due to the reduced functional residual capacity, rapid fall in arterial oxygen tension despite careful maternal positioning and pre-oxygenation may occur during labour and spinal anesthesia. Even with short periods of apnea, either from obstruction of the airway or inhalation of a hypoxic mixture of gasses, the gravida has little defense against the development of hypoxia. Pregnant women with respiratory disorders should undergo lung function test during labour to ascertain the degree of severity and to institute appropriate intervention. These will go a long way in reducing maternal mortality and morbidity and hasten the attainment of Millennium Developmental goal 5 (Reduction in maternal mortality by 75 % by the year 2015). Limitations of this study were the sample size which is small for cross-sectional studies. Future studies need to do with large sample size and if funds and time feasible then longitudinal studies would be better. PFT should be a part of the routine antenatal checkup to prevent any possible respiratory complication.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Assessment ; Pulmonary Function ; Spirometry ; Antenatal Cases. |
| Subjects: | MEDICAL > Physiology |
| Depositing User: | Subramani R |
| Date Deposited: | 19 Dec 2017 12:39 |
| Last Modified: | 19 Dec 2017 12:39 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4502 |
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