Hyperbaric oxygen therapy in carbon monoxide poisoning in pregnancy: Maternal and fetal outcome

  • Abdullah Arslan
    Corresponding author at: Necmettin Erbakan University, Meram Faculty of Medicine, Department of Underwater and Hyperbaric Medicine, Meram, 42080 Konya, Turkey.
    Necmettin Erbakan University, Meram Faculty of Medicine, Department of Underwater and Hyperbaric Medicine, Konya, Turkey
    Search for articles by this author
Published:January 10, 2021DOI:



      Closer monitoring and treatment is vital for pregnant carbon monoxide (CO) poisoning cases due to fetal poisoning component. Permanent damage can occur in both the mother and the baby. It may cause stillbirth even though no serious clinical symptoms occur in the mother. Hyperbaric oxygen (HBO) treatment is advised for all pregnant patients regardless of their clinical symptoms. Pregnant CO poisoning patients that received HBO treatment and their fetal status were evaluated in this study.


      Pregnant patients poisoned with CO treated in the same hyperbaric clinic were evaluated. Pregnant patients that received HBO treatment in a multiplace chamber were evaluated in terms of clinical status, demographic structure, laboratory tests, fetal effects and progress of the fetus until birth and 6 months postpartum.


      A total number of 32 pregnant cases were treated. COHb values were over 20% (min 6.9- max 40.2) in 23 patients, 11 patients had a history of syncope. All patients took HBO treatment under 2.4 ATA pressure for 120 min. 3 patients received more than 1 session of HBO treatments due to fetal stress; all other cases took 1 session of HBO treatment. No spontaneous abortus occurred in early follow-ups; only 4 babies were born prematurely. 2 of the babies were lost in the early phases after birth, due to causes non-related to CO poisoning complications (cyanotic heart disease, necrotising enterocolitis). No significant difference were observed in the comparison of laboratory results of patients with syncope and of those who did not have syncope and comparison of patients with COHb value higher than 20% and patients with COHb value lower than 20% (p > 0.05).


      HBO is not advisable for pregnant patients except for CO poisoning. In this study it is observed that HBO treatment under 2.4 ATA pressure for 120 min has no harmful effects on the mother and the fetus. It is observed that continuation of HBO treatment in the cases with fetal distress findings has beneficial effects. COHb levels and syncope were shown to have no significant effect on clinical symptoms and on blood tests.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hardy K.R.
        • Thom S.R.
        Pathophysiology and treatment of carbon monoxide poisoning.
        J Toxicol Clin Toxicol. 1994; 32: 613-629
        • Ernst A.
        • Zibrak J.D.
        Carbon monoxide poisoning.
        N Engl J Med. 1998; 339: 1603-1608
        • Thom S.R.
        Dehydrogenase conversion to oxidase and lipid peroxidation in brain after carbon monoxide poisoning.
        J Appl Physiol (1985). 1992; 73: 1584-1589
        • Kao L.W.
        • Nañagas K.A.
        Carbon monoxide poisoning.
        Med Clin North Am. 2005; 89: 1161-1194
        • Weaver L.K.
        • Hopkins R.O.
        • Chan K.J.
        • Churchill S.
        • Elliott C.G.
        • Clemmer T.P.
        • et al.
        Hyperbaric oxygen for acute carbon monoxide poisoning.
        N Engl J Med. 2002 Oct 3; 347: 1057-1067
        • Weaver L.K.
        Carbon monoxide poisoning.
        Undersea Hyperb Med. 2020; 47 (PMID: 32176957): 151-169
        • Norman C.A.
        Halton DM. Is carbon monoxide a workplace teratogen? A review and evaluation of the literature.
        Ann Occup Hyg. 1990; 34: 335-347
        • Aubard Y.
        • Magne I.
        Carbon monoxide poisoning in pregnancy.
        BJOG. 2000; 107: 833-838
        • Friedman P.
        • Guo X.M.
        • Stiller R.J.
        • Laifer S.A.
        Carbon monoxide exposure during pregnancy.
        Obstet Gynecol Surv. 2015; 70: 705-712
        • Hampson N.B.
        • Hauff N.M.
        Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture?.
        Am J Emerg Med. 2008; 26: 665-669
        • Elkharrat D.
        • Raphael J.C.
        • Korach J.M.
        • et al.
        Acute carbon monoxide intoxication and hyperbaric oxygen in pregnancy.
        Intensive Care Med. 1991; 17: 289-292
        • Gozubuyuk A.A.
        • Dag H.
        • Kacar A.
        • Karakurt Y.
        • Arica V.
        Epidemiology, pathophysiology, clinical evaluation, and treatment of carbon monoxide poisoning in child, infant, and fetus.
        North Clin Istanb. 2017; 4 (Published 2017 May 10. doi:10.14744/nci.2017.49368): 100-107
        • Hampson N.B.
        • Hauff N.M.
        Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture?.
        Am J Emerg Med. 2008; 26: 665-669
        • Cramer C.R.
        Fetal death due to accidental maternal carbon monoxide poisoning.
        J Toxicol Clin Toxicol. 1982; 19: 297-301
        • Caravati E.M.
        • Adams C.J.
        • Joyce S.M.
        • Schafer N.C.
        Fetal toxicity associated with maternal carbon monoxide poisoning [published correction appears in Ann Emerg med 1988 Oct;17(10):1097].
        Ann Emerg Med. 1988; 17: 714-717
        • Silverman R.K.
        • Montano J.
        Hyperbaric oxygen treatment during pregnancy in acute carbon monoxide poisoning. A case report.
        J Reprod Med. 1997; 42: 309-311
        • Roderique E.J.
        • Gebre-Giorgis A.A.
        • Stewart D.H.
        • Feldman M.J.
        • Pozez A.L.
        Smoke inhalation injury in a pregnant patient: a literature review of the evidence and current best practices in the setting of a classic case.
        J Burn Care Res. 2012; 33: 624-633
        • Hennequin Y.
        • Blum D.
        • Vamos E.
        • Steppe M.
        • Goedseels J.
        • Cavatorta E.
        In-utero carbon monoxide poisoning and multiple fetal abnormalities.
        Lancet. 1993; 341: 240
        • Karabel M.P.
        • Demirbaş M.
        • İnci M.B.
        Changing rates of cesarean section in Turkey and in the world and probable causes.
        Sakarya Tıp Dergisi. 2017; 7: 158-163
        • Jain K.K.
        Carbon monoxide and other tissue poisons.
        in: Textbook of hyperbaric medicine. Springer, Cham2017: 131-154
        • Van Hoesen K.B.
        • Camporesi E.M.
        • Moon R.E.
        • Hage M.L.
        • Piantadosi C.A.
        Should hyperbaric oxygen be used to treat the pregnant patient for acute carbon monoxide poisoning? A case report and literature review [published correction appears in JAMA 1990 May 23-30;263(20):2750].
        JAMA. 1989; 261: 1039-1043
        • Ferm V.H.
        Teratogenıc effects of hyperbarıc oxygen.
        Proc Soc Exp Biol Med. 1964; 116: 975-976
        • Greingor J.L.
        • Tosi J.M.
        • Ruhlmann S.
        • Aussedat M.
        Acute carbon monoxide intoxication during pregnancy. One case report and review of the literature.
        Emerg Med J. 2001; 18: 399-401
        • Koren G.
        • Sharav T.
        • Pastuszak A.
        • et al.
        A multicenter, prospective study of fetal outcome following accidental carbon monoxide poisoning in pregnancy.
        Reprod Toxicol. 1991; 5: 397-403
        • Bitterman N.
        • Bitterman H.
        Oxygen toxicity.
        in: Mathieu D. Handbook on Hyperbaric Medicine. Springer, Dordrecht, the Netherlands2006: 731-766
        • Delomenie M.
        • Schneider F.
        • Beaudet J.
        • Gabriel R.
        • Bednarek N.
        • Graesslin O.
        Carbon monoxide poisoning during pregnancy: presentation of a rare severe case with Fetal bladder complications.
        Case Rep Obstet Gynecol. 2015; 2015687975
        • Mathieu D.
        • Marroni A.
        • Kot J.
        Tenth European consensus conference on hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment [published correction appears in diving hyperb med. 2017 Jun;47(2):131-132].
        Diving Hyperb Med. 2017; 47: 24-32
        • Kopelman A.E.
        • Plaut T.A.
        Fetal compromise caused by maternal carbon monoxide poisoning.
        J Perinatol. 1998; 18: 74-77
        • Wattel F.
        • Mathieu D.
        • Mathieu-Nolf M.
        Devenir des enfants intoxiqués au monoxyde de carbone en période foetale et traités par oxygéno- thérapie hyperbare--etude d’une cohorte constituée sur 25 ans de 1983 a 2008 [A 25-year study (1983–2008) of children’s health outcomes after hyperbaric oxygen therapy for carbon monoxide poisoning in utero].
        Bull Acad Natl Med. 2013 Mar; 197 (discussion 695–7. French. PMID: 25163349): 677-694