Carbon Monoxide Poisoning in Pregnancy: What to Do in Adults Aged 18 and Over
Clinical Scenario
This protocol addresses carbon monoxide (CO) poisoning in pregnant patients aged 18 years and over — a population in whom rapid, structured management is especially critical given the implications for both patient and fetus.
Pregnancy is considered by many clinicians to be a strict indication for escalated treatment, particularly when neurological symptoms, signs of fetal stress, syncope, or an elevated COHb level are present.
Treatment Approach (Partial Overview)
Immediate delivery of oxygen at the highest achievable concentration is the central initial intervention — with the choice of delivery method guided by the patient's clinical status and airway protective reflexes. The complete protocol, including the full sequence of interventions and criteria for continuation, is available below.
Treatment Target
Treatment continues until the COHb level has returned to normal values (<3%) and the patient is symptom-free.
References
In the case of signs of severe CO poisoning (including continued impaired consciousness, metabolic acidosis, respiratory insufficiency, and/or cardiac ischemia), as well as during pregnancy, HBOT ought to be administered in adults (aged 18 years and over).
Thus, some authors consider pregnancy to be a strict indication for HBOT, especially when neurological symptoms, signs of fetal stress, syncope, or a high COHb level are present.
If CO poisoning is suspected, 100% oxygen or ventilation should be started immediately.
Regardless of the oxygen saturation (SpO2), oxygen should be administered immediately at the highest possible concentration.
Mask continuous positive airway pressure (CPAP) (non-invasive ventilation, NIV) or Demand valve or Constant dosing (high-flow) via tight-fitting mask with reservoir bag or Invasively using appropriate airway protection if protective reflexes are inadequate.
Treatment must be continued until the COHb level has dropped to normal values (<3%) and the 36 is symptom-free.
View source ↗