0
February 17, 1989, Vol 261, No. 7 >
ARTICLE | February 17, 1989

Should Hyperbaric Oxygen Be Used to Treat the Pregnant Patient for Acute Carbon Monoxide Poisoning?: Title and subTitle BreakA Case Report and Literature Review FREE

Karen B. Van Hoesen, MD; Enrico M. Camporesi, MD; Richard E. Moon, MD; Marvin L. Hage, MD; Claude A. Piantadosi, MD
[+] Author Affiliations

Reprint requests to the Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710 (Dr Camporesi).


JAMA. 1989;261(7):1039-1043. doi:10.1001/jama.1989.03420070089037
Text Size: A A A
Published online
Article
References

Carbon monoxide (CO) is the leading cause of death due to poisoning. Although uncommon, CO poisoning does occur during pregnancy and can result in fetal mortality and neurological malformations in fetuses who survive to term. Uncertainty arises regarding the use of hyperbaric oxygen (HBO) as a treatment for the pregnant patient because of possible adverse effects on the fetus that could be induced by oxygen at high partial pressures. While the dangers of hyperoxia to the fetus have been demonstrated in animal models, careful review of animal studies and human clinical experience indicates that the short duration of hyperoxic exposure attained during HBO therapy for CO poisoning can be tolerated by the fetus in all stages of pregnancy and reduces the risk of death or deformity to the mother and fetus. A case is presented of acute CO poisoning during pregnancy that was successfully treated with HBO. Recommendations are suggested for the use of HBO during pregnancy.

(JAMA 1989;261:1039-1043)

REFERENCES

1 +
Winter PM, Miller JN:  Carbon monoxide poisoning . JAMA 1976;;236:1502-1504.
2 +
Astrup P, Olsen HM, Trolle D, et al:  Effect of moderate carbon monoxide exposure on fetal development . Lancet 1972;;2:1220-1222.
3 +
Ginsberg MD, Myers RE:  Fetal brain injury after maternal carbon monoxide intoxication . Neurology 1976;;26:15-23.
4 +
Longo LD:  The biological effects of carbon monoxide on the pregnant woman, fetus and newborn infant . Am J Obstet Gynecol 1977;;129:69-103.
5 +
Muller GL, Graham S:  Intrauterine death of the fetus due to accidental carbon monoxide poisoning . N Engl J Med 1955;;252:1075-1078.
6 +
Hollander DI, Nagey DA, Welch R, et al:  Hyperbaric oxygen therapy for the treatment of acute carbon monoxide poisoning in pregnancy . J Reprod Med 1987;;32:615-617.
7 +
Jennings RT:  Women and the hazardous environment: When the pregnant patient requires hyperbaric oxygen therapy . Aviat Space Environ Med 1987;;58:370-374.
8 +
Margulies JL:  Acute carbon monoxide poisoning during pregnancy . Am J Emerg Med 1986;;4:516-519.
9 +
Marzella L, Myers RAM:  Carbon monoxide poisoning . Am Fam Physician 1986;;34:186-194.
10 +
Longo LD:  Carbon monoxide in the pregnant mother and fetus and its exchange across the placenta . Ann NY Acad Sci 1970;;174:313-341.
11 +
Kindwall E:  Carbon monoxide and cyanide poisoning , in Davis JC, Hunt TK (eds): Hyperbaric Oxygen Therapy . Bethesda, Md, Undersea Medical Society Inc, 1977;, pp 177-190.
12 +
Piantadosi CA:  Carbon monoxide, oxygen transport and oxygen metabolism . J Hyperbaric Med 1988;;2:27-44.
13 +
Longo LD, Hill EP:  Carbon monoxide uptake and elimination in fetal and maternal sheep . Am J Physiol 1977;;232:H324-H330.
14 +
Hill EP, Hill JR, Power GG, et al:  Carbon monoxide exchanges between the human fetus and mother: A mathematical model . Am J Physiol 1977;;232:H311-H323.
15 +
Ginsberg MD, Myers RE:  Fetal brain damage following maternal carbon monoxide intoxication: An experimental study . Acta Obstet Gynecol Scand 1974;;53:309-317.
16 +
Schwetz BA, Smith FA, Leong BKL, et al:  Teratogenic potential of inhaled carbon monoxide in mice and rabbits . Teratology 1979;;19:385-392.
17 +
Cramer CR:  Fetal death due to accidental maternal carbon monoxide poisoning . J Toxicol Clin Toxicol 1982;;19:297-301.
18 +
Pace N, Strajman E, Walker EL:  Acceleration of carbon monoxide elimination in man by high pressure oxygen . Science 1950;;111:652-654.
19 +
Peterson JE, Stewart RD:  Absorption and elimination of carbon monxide by inactive young men . Arch Environ Health 1970;;21:165-171.
20 +
Ferm VH:  Teratogenic effects of hyperbaric oxygen . Proc Soc Exp Biol Med 1964;;116:975-976.
21 +
Fujikura T:  Retrolental fibroplasia and prematurity in newborn rabbits induced by maternal hyperoxia . Am J Obstet Gynecol 1964;;90:854-858.
22 +
Telford IR, Miller PD, Haas GF:  Hyperbaric oxygen causes fetal wastage in rats . Lancet 1969;;2:220-221.
23 +
Miller PD, Telford ID, Haas GR:  Effect of hyperbaric oxygen on cardiogenesis in the rat . Biol Neonate 1971;;17:44-52.
24 +
Cho SH, Yun DR:  The experimental study on the effect of hyperbaric oxygen on the pregnancy wastage of rats with acute carbon monoxide poisoning . Seoul J Med 1982;;23:67-75.
25 +
Gilman SC, Bradley ME, Greene KM, et al:  Fetal development: Effects of decompression sickness and treatment . Aviat Space Environ Med 1983;;54:1040-1042.
26 +
Gilman SC, Greene KM, Bradley ME, et al:  Fetal development: Effects of simulated diving and hyperbaric oxygen treatment . Undersea Biomed Res 1983;;9:297-304.
27 +
United States Navy Diving Manual . San Pedro, Calif, Best Publishing Co, 1985;, vol 1, p 36.
28 +
Assali NS, Kirschbaum THL, Dilts PV:  Effects of hyperbaric oxygen on uteroplacental and fetal circulation . Circ Res 1968;;22:573-588.
29 +
Aksenova A, Proshina IV, Smirnova LK, et al:  Methods of prenatal diagnosis of fetal hypoxia and control of the effectiveness of its treatment with hyperbaric oxygen . Akush Ginekol 1979;;11:15-18.
30 +
Molzhaninov EV, Chaika VK, Domanova AI, et al:  Experience and prospects of using hyperbaric oxygenation in obstetrics , in Proceedings of the Seventh International Congress on Hyperbaric Medicine, Moscow, 1981 . Moscow, Nauka, 1983;, vol 1, pp 139-141.
31 +
Pobedinskiy NM, Proshina IV, Fanchenko ND, et al:  Hyperbaric oxygen in the treatment of reproductive function of women , in Proceedings of the Seventh International Congress on Hyperbaric Medicine, Moscow, 1981 . Moscow, Nauka, 1983;, vol 1, pp 133-136.
32 +
Proshina IV, Kuzmina NV, Borisenko SS:  Hyperbaric oxygenation in the prevention and treatment of toxemia of pregnancy and placental insufficiency . Akush Ginekol 1983;;6:20-23.
33 +
Stepanyants NA, Grinshpun EL, Popov VA, et al:  Hyperbaric oxygenation in the complex treatment of late toxicosis of pregnancy , in Proceedings of the Seventh International Congress on Hyperbaric Medicine, Moscow, 1981 . Moscow, Nauka, 1983;, vol 1, pp 137-138.
34 +
Vanina LV, Yefuni SN, Beilin AL, et al:  Obstetrics aid in hyperbaric conditions , in Proceedings of the Seventh International Congress on Hyperbaric Medicine, Moscow, 1981 . Moscow, Nauka, 1983;, vol 1, pp 26-28.
35 +
Ledingham IM, McBride TI, Jennett WB, et al:  Fatal brain damage associated with cardiomyopathy of pregnancy with notes on caesarean section in a hyperbaric chamber . Br Med J 1968;;4:285-287.
36 +
Kindwall EP, Goldmann RW: Hyperbaric Medicine Procedures . Milwaukee, St Luke's Hospital, 1970;, pp 60, 90-98.
37 +
Hyperbaric Oxygen Therapy: A Committee Report . Bethesda, Md, Undersea and Hyperbaric Medical Society Inc, 1986;, pp 33-36.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Winter PM, Miller JN:  Carbon monoxide poisoning . JAMA 1976;;236:1502-1504.
2 +
Astrup P, Olsen HM, Trolle D, et al:  Effect of moderate carbon monoxide exposure on fetal development . Lancet 1972;;2:1220-1222.
3 +
Ginsberg MD, Myers RE:  Fetal brain injury after maternal carbon monoxide intoxication . Neurology 1976;;26:15-23.
4 +
Longo LD:  The biological effects of carbon monoxide on the pregnant woman, fetus and newborn infant . Am J Obstet Gynecol 1977;;129:69-103.
5 +
Muller GL, Graham S:  Intrauterine death of the fetus due to accidental carbon monoxide poisoning . N Engl J Med 1955;;252:1075-1078.
6 +
Hollander DI, Nagey DA, Welch R, et al:  Hyperbaric oxygen therapy for the treatment of acute carbon monoxide poisoning in pregnancy . J Reprod Med 1987;;32:615-617.
7 +
Jennings RT:  Women and the hazardous environment: When the pregnant patient requires hyperbaric oxygen therapy . Aviat Space Environ Med 1987;;58:370-374.
8 +
Margulies JL:  Acute carbon monoxide poisoning during pregnancy . Am J Emerg Med 1986;;4:516-519.
9 +
Marzella L, Myers RAM:  Carbon monoxide poisoning . Am Fam Physician 1986;;34:186-194.
10 +
Longo LD:  Carbon monoxide in the pregnant mother and fetus and its exchange across the placenta . Ann NY Acad Sci 1970;;174:313-341.
11 +
Kindwall E:  Carbon monoxide and cyanide poisoning , in Davis JC, Hunt TK (eds): Hyperbaric Oxygen Therapy . Bethesda, Md, Undersea Medical Society Inc, 1977;, pp 177-190.
12 +
Piantadosi CA:  Carbon monoxide, oxygen transport and oxygen metabolism . J Hyperbaric Med 1988;;2:27-44.
13 +
Longo LD, Hill EP:  Carbon monoxide uptake and elimination in fetal and maternal sheep . Am J Physiol 1977;;232:H324-H330.
14 +
Hill EP, Hill JR, Power GG, et al:  Carbon monoxide exchanges between the human fetus and mother: A mathematical model . Am J Physiol 1977;;232:H311-H323.
15 +
Ginsberg MD, Myers RE:  Fetal brain damage following maternal carbon monoxide intoxication: An experimental study . Acta Obstet Gynecol Scand 1974;;53:309-317.
16 +
Schwetz BA, Smith FA, Leong BKL, et al:  Teratogenic potential of inhaled carbon monoxide in mice and rabbits . Teratology 1979;;19:385-392.
17 +
Cramer CR:  Fetal death due to accidental maternal carbon monoxide poisoning . J Toxicol Clin Toxicol 1982;;19:297-301.
18 +
Pace N, Strajman E, Walker EL:  Acceleration of carbon monoxide elimination in man by high pressure oxygen . Science 1950;;111:652-654.
19 +
Peterson JE, Stewart RD:  Absorption and elimination of carbon monxide by inactive young men . Arch Environ Health 1970;;21:165-171.
20 +
Ferm VH:  Teratogenic effects of hyperbaric oxygen . Proc Soc Exp Biol Med 1964;;116:975-976.
21 +
Fujikura T:  Retrolental fibroplasia and prematurity in newborn rabbits induced by maternal hyperoxia . Am J Obstet Gynecol 1964;;90:854-858.
22 +
Telford IR, Miller PD, Haas GF:  Hyperbaric oxygen causes fetal wastage in rats . Lancet 1969;;2:220-221.
23 +
Miller PD, Telford ID, Haas GR:  Effect of hyperbaric oxygen on cardiogenesis in the rat . Biol Neonate 1971;;17:44-52.
24 +
Cho SH, Yun DR:  The experimental study on the effect of hyperbaric oxygen on the pregnancy wastage of rats with acute carbon monoxide poisoning . Seoul J Med 1982;;23:67-75.
25 +
Gilman SC, Bradley ME, Greene KM, et al:  Fetal development: Effects of decompression sickness and treatment . Aviat Space Environ Med 1983;;54:1040-1042.
26 +
Gilman SC, Greene KM, Bradley ME, et al:  Fetal development: Effects of simulated diving and hyperbaric oxygen treatment . Undersea Biomed Res 1983;;9:297-304.
27 +
United States Navy Diving Manual . San Pedro, Calif, Best Publishing Co, 1985;, vol 1, p 36.
28 +
Assali NS, Kirschbaum THL, Dilts PV:  Effects of hyperbaric oxygen on uteroplacental and fetal circulation . Circ Res 1968;;22:573-588.
29 +
Aksenova A, Proshina IV, Smirnova LK, et al:  Methods of prenatal diagnosis of fetal hypoxia and control of the effectiveness of its treatment with hyperbaric oxygen . Akush Ginekol 1979;;11:15-18.
30 +
Molzhaninov EV, Chaika VK, Domanova AI, et al:  Experience and prospects of using hyperbaric oxygenation in obstetrics , in Proceedings of the Seventh International Congress on Hyperbaric Medicine, Moscow, 1981 . Moscow, Nauka, 1983;, vol 1, pp 139-141.
31 +
Pobedinskiy NM, Proshina IV, Fanchenko ND, et al:  Hyperbaric oxygen in the treatment of reproductive function of women , in Proceedings of the Seventh International Congress on Hyperbaric Medicine, Moscow, 1981 . Moscow, Nauka, 1983;, vol 1, pp 133-136.
32 +
Proshina IV, Kuzmina NV, Borisenko SS:  Hyperbaric oxygenation in the prevention and treatment of toxemia of pregnancy and placental insufficiency . Akush Ginekol 1983;;6:20-23.
33 +
Stepanyants NA, Grinshpun EL, Popov VA, et al:  Hyperbaric oxygenation in the complex treatment of late toxicosis of pregnancy , in Proceedings of the Seventh International Congress on Hyperbaric Medicine, Moscow, 1981 . Moscow, Nauka, 1983;, vol 1, pp 137-138.
34 +
Vanina LV, Yefuni SN, Beilin AL, et al:  Obstetrics aid in hyperbaric conditions , in Proceedings of the Seventh International Congress on Hyperbaric Medicine, Moscow, 1981 . Moscow, Nauka, 1983;, vol 1, pp 26-28.
35 +
Ledingham IM, McBride TI, Jennett WB, et al:  Fatal brain damage associated with cardiomyopathy of pregnancy with notes on caesarean section in a hyperbaric chamber . Br Med J 1968;;4:285-287.
36 +
Kindwall EP, Goldmann RW: Hyperbaric Medicine Procedures . Milwaukee, St Luke's Hospital, 1970;, pp 60, 90-98.
37 +
Hyperbaric Oxygen Therapy: A Committee Report . Bethesda, Md, Undersea and Hyperbaric Medical Society Inc, 1986;, pp 33-36.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems