Acute carbon monoxide intoxication during pregnancy. One case report and review of the literature

Acute carbon monoxide (CO) poisoning during pregnancy is an uncommon event, but failing to recognise maternal CO intoxication can have a dramatic eVect on the fetus.To limit the toxic eVects of CO, the use of hyperbaric oxygen is usually recommended.We report the case of one patient admitted for acute CO poisoning during pregnancy. Case reportA 31 year old (gravida 4, para 3) at 21 weeks gestational age was exposed to CO. CO was produced by a defective water heater.She did not lose consciousness and her vital signs were: regular pulse rate of 90 beats per minute, blood pressure of 100/80 mm Hg and respirations of 201/mn.Physical examination was unremarkable.She complained of dizziness and palpitation.She was promptly removed from the source of CO.The patient received 9 l/mn supplemental oxygen by face mask.A level of 24.6% carboxyhaemoglobin was measured in the expired air.High flow oxygen therapy was started immediately.The patient was then treated with 100% O 2 at 2.5 atmospheres absolute for 90 minutes.Treatment with hyperbaric oxygen was started in the 30 minutes after the end of exposure.Sonography confirmed the presence of fetal heart tone of 140/mn.She was discharged in good health one day after exposure.The patient delivered at term a healthy male infant weighing 3800 g. DiscussionCO intoxication is the most frequently reported poisoning in Western developed countries.In England and Wales acute CO poisoning was responsible for 877 deaths in 1996. 1 In France and in the USA, CO is the leading cause of death by poisoning.2 3 Many situations result in the production of CO.Signs are variable and non-specific and may easily be confused with those of other disorders.This explains the diYculty of a diagnosis of acute CO intoxication.Hardy estimates that nearly one third of all cases may go undiagnosed.4 Breslau and Freund were responsible for the first published report of acute CO intoxication in pregnant women.Breslau reported the intoxication of two pregnant women admitted to a Zurich hospital after a gas explosion.5 One woman had an apparently normal child at delivery, but the other suVered a stillbirth: the death occurring one day after exposure.Freund reported a death in utero during the seventh month of gestation.6 The frequency of acute CO poisoning during pregnancy is diYcult to estimate.