Carbon monoxide intoxication during pregnancy: a case presentation and pathophysiologic discussion, with emphasis on molecular mechanisms.

In carbon monoxide (CO) poisoning, the mortality and morbidity risk does not always correlate with the level of carboxyhemoglobin (COHb). Recent studies confirm that the mitochondrial cytochrome portion of the respiratory chain is susceptible to CO toxicity at concentrations traditionally considered nontoxic. These laboratory findings correlate with subtle neurologic symptoms detected by psychometric studies in individuals many days from the time of acute intoxication. Additionally, in the pregnant patient, a time lag for both uptake and elimination of CO between the mother and fetus has been demonstrated, with the fetus at risk for hypoxia even when the mother's blood level of CO is nontoxic. Hyperbaric oxygen (HBO) therapy in pregnant patients has not been shown to have adverse effects on the fetus. We present a case of CO intoxication in late pregnancy treated with HBO therapy without adverse consequences.