Hyperbaric oxygen treatment during pregnancy in acute carbon monoxide poisoning. A case report.

BACKGROUND: Carbon monoxide poisoning in pregnancy is a relatively rare occurrence, with potentially serious complications for both mother and fetus. Controversy regarding treatment during pregnancy exists primarily due to the concern for oxygen toxicity in the fetus. However, rapid oxygen dissociation and prolonged clearance of carbon monoxide in the fetal circulation emphasize the importance of adhering to aggressive treatment protocols. CASE: A 22-year-old employee at an office undergoing repairs on the heating and ventilation systems presented with neurologic symptoms, tachycardia, tachypnea, signs of preterm labor and a carboxyhemoglobin level that was mildly elevated. Fetal monitoring demonstrated a reactive nonstress test with mild to moderate repetitive variable decelerations. The patient underwent hyperbaric oxygen treatment, with complete resolution of her neurologic symptoms, tachycardia and tachypnea as well as fetal variable decelerations. She was additionally treated with intravenous magnesium sulfate tocolysis, with cessation of contractions. The patient subsequently delivered at term; the viable infant had no sequelae of in utero carbon monoxide poisoning.
CONCLUSION: This case supports previously published recommendations for treating acute carbon monoxide poisoning during pregnancy with hyperbaric oxygen. As more cases are gathered, a more widely accepted set of standards can be established.