BMJ 2011: 342: 1035 – 1092 (14th May)

It’s official – we can give beta-blockers to COPD patients with CCF.  The benefits outweigh the risks, though we’re meant to give a supervised first dose to minimise risk in those rare patients who do have severe bronchospasm.

The main article is about considerations in travel advice for the pregnant woman.  Since the second trimester is the safest from the point of view of medical complications, it’s also the safest time to travel; in the first and last trimesters you have to give more consideration to what would happen if you developed a complication miles from anywhere.  Bear in mind the particular woman’s risk of complications, any worrying symptoms, and available travel insurance in case a problem does arise.  The ACOG advises air travel to be safe up to 36 weeks in healthy women with uncomplicated singleton pregnancies, and most airlines will let you fly up until 36 + 6, or 32 + 6 in multiple pregnancies, although a letter from a doctor or midwife is needed after 28 weeks.

Particular risks to bear in mind:

Miscarriage/preterm birth: Risk appears to be increased by flying, though quality of available evidence is not brilliant.

VTE: Probable increased risk.  Consider compression stockings, though not clear whether they reduce risk in pregnant women flying.

Radiation exposure: Increased in air travel.  However, exposure from a 10-hour flight is estimated to be about a hundredth of the level thought to be the safe limit in pregnancy, so not really an issue except for very frequent fliers.

Low oxygen saturation: Not an issue for the fetus under usual circumstances, due to the greater affinity that fetal haemoglobin has for oxygen, but can be risky for women with pre-existing cardiovascular problems, sickle cell disease, or a haemoglobin below 8.0.  These women should avoid air travel if possible or consider supplemental oxygen if it can’t be avoided.

Risks from communicable disease in the area travelled to: Where are they stepping off the plane at the other end?  Is it somewhere where traveller’s diarrhoea, malaria, or obscure diseases are likely to be a factor?  If travel to a malarial endemic area is unavoidable, prophylaxis is advised.  (Placental sequestration of the malarial parasite may make diagnosis on a blood film more difficult.)  Vaccination, where appropriate, is likely to be safe where the vaccine is with inactivated virus, bacterial vaccination, or toxoids, but are best avoided with live vaccines such as yellow fever – send woman with a letter to minimise risk of her being turned away on arrival.

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in BMJ, COPD, Pregnancy and Childbirth. Bookmark the permalink.

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