Pregnancy

Guidance for medical examiners when assessing a patient for either a general topic or condition - Pregnancy. This Clinical Practice Guideline applies to holders of Class 1, 2, or 3 medical certificates that become pregnant.

Definition

Relevant regulation

CASR 1998 contains the following provisions related to pregnancy.

67.010 Definitions for this Part

medically significant condition includes:

(d) for a woman—pregnancy and the physiological and psychological consequences of pregnancy or of termination of pregnancy.

Regulation 67.150 (1.24) / 67.155 (2.23) / 67.160 (3.22)

Gynaecological and obstetrical

If pregnant—the pregnancy is not likely to interfere with the safe exercise of privileges, or performance of duties, under the licence held or applied for

Note: See regulation 67.235 regarding the periods during which a pregnant woman must not exercise the privileges of a licence.

67.235 Suspension of medical certificates—pregnancy

  1. A medical certificate held by a pregnant woman who holds, or is an applicant for, a licence is taken to be suspended:
    1. during the period beginning immediately after the end of the 30th week of gestation and ending when a DAME certifies that she is fully recovered following delivery or the termination of the pregnancy
    2. if in a particular case CASA directs in writing that a different period should apply—during the period so directed by CASA
    3. if, before the start of the period mentioned in paragraph (a), the pregnancy ends in miscarriage or premature labour, or is terminated by medical intervention—from the time of the miscarriage, premature labour or intervention until a DAME certifies that the woman is fully recovered

      Note: This regulation does not preclude a pilot who is pregnant from undertaking or receiving instruction in a flight simulator at any stage of the pilot‘s pregnancy.

  2. Despite subregulation (1), a pregnant woman who holds an air traffic controller licence may continue to exercise the privileges of the licence until the end of the 38th week of gestation if:
    1. the medical practitioner who is attending the woman certifies her continued medical fitness to do so each week beginning at the 31st week of gestation
    2. a DAME certifies the woman‘s continuing fitness to do so each week beginning at the 31st week of gestation
    3. another person who holds an air traffic controller licence, and is medically fit and able to take over responsibility for the function, is on duty and available at the times when she does so.

Aeromedical implications

Pregnancy under normal circumstances can be compatible with flying and controlling duties.  However, the certificate holder’s obstetrician should be made aware of the relevant considerations of the aviation environment in order to properly advise of the safety (or otherwise) of flying or controlling when pregnant.

The following effects should be considered.

Effect of aviation on condition

  • Cosmic radiation, especially for long-haul high latitude flights
  • Prolonged sitting in restricted posture
  • Limited access to toilet facilities
  • Risk of trauma from turbulence or accident
  • Possible exposure to physical hazards, including radiation, noise, fuels, and cabin air contamination
  • Adverse effect of vibration on fetus
  • Adverse effect of aerobatics

Effect of condition on aviation

  • Fatigue and daytime sleepiness
  • Neurocognitive impairment, including concentration, memory and speed of processing
  • Mood lability
  • Decrease in visual acuity
  • Back and pelvis pain, especially with prolonged sitting
  • Pregnancy-related nausea (‘morning sickness’)
  • Anaemia
  • Postural hypotension and syncope
  • Increasing abdominal size may interfere with flight controls
  • Risk from miscarriage or premature labour
  • Pre-eclampsia and eclampsia

Approach to medical certification

Based on the condition

  • Single, intrauterine pregnancy
  • Uncomplicated pregnancy
  • No aeromedically significant symptoms
  • Rotary-wing – vibration
  • Aerobatics

Demonstrated stability

  • Absence of aeromedically significant symptoms, including fatigue and daytime drowsiness, cognitive slowing or memory lapses
  • Clinically stable – blood pressure, BSL, haemoglobin
  • Acceptable biochemical and haematology results
  • Stable visual acuity

Risk assessment protocol - information required

New cases

  • Confirmed diagnosis
  • Evidence of clinical stability
  • Assessment of symptoms, including assessment of fatigue, cognitive function
  • Continues to meet visual standard for the relevant certificate
  • Obstetric reports
  • Ultrasound report confirming intrauterine pregnancy

Surveillance during pregnancy

  • Stability re-affirmed with a clinical examination no less frequently than every 2 weeks

Indicative outcomes

Favourable

  • Normal, uncomplicated pregnancy
  • Single, intrauterine pregnancy
  • Absence of significant symptoms:
    • no nausea or vomiting
    • no significant fatigue or daytime drowsiness
    • no significant cognitive impairment or memory lapses
    • no significant polyuria or urinary frequency.

Unfavourable

  • Complicated pregnancy
  • Multiple pregnancy
  • History of miscarriage or premature labour
  • Unstable symptoms
    • faintness
    • morning sickness
    • anaemia
    • gestational diabetes
    • hypertension
  • Significant headaches, back pain
  • Assessment of cognitive impairment (including processing speed, and memory lapses), including subjective assessment of certificate holder
  • Unstable visual acuity or acuity that falls below standard for the relevant certificate.

Information for the certificate holder

Flying and controlling are physically and physiologically demanding tasks, and changes due to pregnancy which normally cause only inconvenience can have significant safety implications in the aviation environment. A certificate holder should ground herself as soon as she becomes aware she is pregnant, and seek advice of her DAME prior to returning.

Restricting flying/controlling duties during the first trimester should be considered, given the high prevalence of morning sickness, and the higher risk of miscarriage.

A certificate holder can resume flying or controlling duties provided:

  • the pregnancy is uncomplicated
  • the DAME and obstetrician agree that it is safe to resume duties
  • for a Class 1 certificate holder, a Multi-Crew Restriction is attached
  • for a Class 3 certificate holder, a proximity restriction is placed after 30th week of gestation.

Pregnancy induces progressive changes in a woman’s body. To meet these changing circumstances, a DAME should assess a certificate holder no less frequently than every 2 weeks to re-affirm her fitness to continue flying or controlling.

Legal disclaimer: Multiple risks associated with pregnancy and the operational environment. These are beyond the scope of Civil Aviation Law, but need to be considered by a pregnant pilot.

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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