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Risks of and recommendations for flexible bronchoscopy in pregnancy: a review.

G enerally, medical procedures such as flexible bronchoscopy (FB) are avoided in pregnancy as a result of procedureand sedation-related risks to the mother and the fetus. However, there are situations in which these procedures might be diagnostically or therapeutically indicated and should not be delayed. The current published knowledge about FB in pregnancy is limited to a few case reports1–8 and one review article9; however, upper and lower GI endoscopy during pregnancy is well described, and the lessons learned may be partially extrapolated to FB. The published studies on endoscopy during pregnancy are mostly retrospective and small.10 The only exception is a large, case-control study11 comparing 83 pregnant women undergoing esophagogastroduodenoscopy with matched pregnant (not undergoing the procedure) and nonpregnant (undergoing the same procedure) women as control subjects. The study reported no increase in adverse events among the pregnant treatment group. However, statistical power was insufficient to exclude a small, but clinically important, fetal risk from endoscopy. Bronchoscopy during pregnancy has its own specific risks from inserting instruments into the airway, such as impaired gas exchange, severe violent cough, and barotrauma (pneumothorax and pneumomediastinum), which may actually be more hazardous to the pregnant patient. Medications used during endoscopy, and thus bronchoscopy, seem to be responsible for many of the endoscopic risks during pregnancy, but their risks are imprecisely defined, apart from the direct effect of each drug on the fetus. In this review, we describe the major issues of performing FB in pregnant women, such as changes in the respiratory system, the potential risks associated with FB, the major indications for FB, the use of diagnostic radiation, and the monitoring of the mother and the fetus during FB. Finally, we list some general recommendations for performing bronchoscopy in pregnant patients.