You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
kyphoscoliosis occurs due to disruption of balance between structural and dynamic components or neuromuscular elements of the spine .
the respiratory system is compromised , and its severity depends on the severity of the kyphoscoliosis and concomitant respiratory disease .
a 27-year - old , 45 kg female , g1p0l0a0 , was admitted at 29 weeks of gestation with complaints of moderate grade fever associated with chills and rigors since 3 weeks , followed by development of cough and difficulty in breathing .
her past history revealed gradually progressing thoracic kyphoscoliosis following poliomyelitis diagnosed at the age of 4 months . on admission ,
the patient was diagnosed to have signs and symptoms of ards with bilateral lung infiltrates in chest x - ray .
hemogram , renal and liver functions revealed no abnormality except for a total protein of 4.5 gm% , positive peripheral smear for malaria parasite ( plasmodium falciparum ) and total leukocyte count of 14,700/mm .
pulmonary function test revealed a restrictive lung disease ( forced vital capacity [ fvc ] , forced expiratory volume [ fev1 ] and fev1/fvc were 67% , 58% and 110% , respectively ) .
other causes of fever such as typhoid , hepatitis , urinary tract infection and cholangitis were ruled out .
she was admitted to intensive care unit ( icu ) and ards was managed with intravenous antibiotics cefotaxim 1 g 8 hourly , levofloxacin 500 mg once in 24 h , amikacin 500 mg 12 hourly and metronidazole 500 mg 8 hourly .
she was administered oxygen by face mask ( 5 - 6 l / min ) , steam inhalation , nebulization and chest physiotherapy .
there was gradual worsening of her respiratory condition , subsequently leading to desaturation ( spo2 77% ) with a respiratory rate ( rr ) of 50 - 60 breaths / min , and crepts on auscultation of her right chest .
her arterial blood gas ( abg ) analysis revealed po2 - 64 mmhg , pco2 - 26 mmhg , spo2 of 88% for which noninvasive continuous positive airway pressure ( cpap ) of 5 cmh2o was applied with a fio2 of 40% .
this led to an improvement of her respiratory condition ; spo2 rose to 99% and the rr settled to 20 - 22 breaths / min .
repeat abg revealed po2 - 96 mmhg , pco2 - 34 mmhg and spo2 99% .
she continued to remain on noninvasive cpap for first 4 days , maintaining hemodynamics and was managed with intravenous antibiotic , steroids and nebulization with bronchodilators . in the icu she developed hyponatremia ( na 128 meq / l ) and hypoprotenemia ( total proteins 4.5 g / dl and albumin 1.8 g / dl ) .
hypoproteinemia was managed with albumin ( 20% 100 ml daily for 5 days ) and hyponatremia with 0.9% normal saline administration . during her icu
she was administered intramuscular betamethasone ( 12 mg , 2 doses 24 h apart ) for fetal lung maturity .
tocolytics were also prescribed for occasional uterine contractions ( nifedipine 5 - 10 mg when required ) . on day 5 of her icu
stay , she had respiratory distress ( rr-26 - 28 breaths / min ) and started having labor pains . on examination ,
this was followed by deterioration of her respiratory condition and desaturation ( spo2 of 73% ) even on the support of noninvasive cpap of 5 cmh2o .
her abg revealed po2 - 52 mmhg , pco2 - 45 mmhg and spo2 of 82% .
fetal doppler revealed fetal heart rate of 110 beats / min . in view of such critical condition ,
rapid sequence induction using thiopentone ( 200 mg ) and succinylcholine ( 75 mg ) was performed , followed by tracheal intubation .
patient was then shifted to the operating room in left lateral position with an endotracheal tube in situ on bain 's circuit and with manual assisted ventilation . during the surgery
, patient remained hemodynamically stable with systolic blood pressure ranging 110 - 140 mmhg , diastolic blood pressure ranging 60 - 80 mmhg and heart rate ranging from 60 to 80 beats / min .
she sustained blood loss of 600 ml that was replaced with balanced salt solution and 1 unit of packed red blood cells . a low birth weight ( 1181 g )
female baby was delivered with an apgar score of 7 and 8 at 1 and 5 min respectively .
baby was shifted to neonatal icu for further management . in view of her poor lung condition ,
the lung condition further deteriorated , and abg revealed - ph 7.321 , pao2 59 mmhg , paco2 46 mmhg , hco3 20
her bronchial alveolar lavage cultures grew acinetobacter and urine culture revealed escherichia coli that were managed with appropriate intravenous antibiotics . during this period in icu , she required sedation with midazolam and morphine as well as intermittent neuromuscular blockade and inotropic support ( noradrenalin 5 - 8 mg / kg ) . over next 4 days , her lung condition and abg improved with the gradual increase in pao2 of 65 mmhg to 202 mmhg and pao2/fio2 ratio of 81.25 - 505 .
this led to gradual weaning of the patient off the ventilator and finally tracheal extubation 10 days later .
anesthetic management of the parturient with thoracic kyphoscoliosis , malaria and ards for emergency lscs is challenging .
pregnant patients with pulmonary compromise ( kyphoscoliosis and ards in this case ) may not tolerate increased metabolic demand generated by the fetus , placenta , and gravid uterus due to limited respiratory reserves .
labor pains result in marked hyperventilation causing a fall in paco2 and respiratory alkalosis causing cerebral and uteroplacental vasoconstriction .
this reduces the release of oxygen from hemoglobin that not only compromises maternal tissue oxygenation , but also has a deleterious effect on fetal oxygen transfer .
the presence of kyphoscolisos in parturient may further leads to ventilation / perfusion mismatch and marked dyspnea .
it can also interfere with provision of labor analgesia or regional anesthesia for cesarean section .
the risk of development of ards in a parturient is higher than in the nonpregnant population . golden hour 
we conclude that parturient with associated respiratory comorbidities needs timely management for a better outcome not only of the mother , but also of the fetus .
the management of cesarean section in kyphoscoliotic patient is challenging . the respiratory changes and increased metabolic demands due to pregnancy may compromise the limited respiratory reserves in such patients . 
 presence of other comorbidities like malaria and respiratory tract infection will further compromise the effective oxygenation . 
 we report a case of kyphoscoliosis along with malaria and acute respiratory distress syndrome for urgent cesarean section .