Skip to Main Content

++

INTRODUCTION

++

A majority of women experience subjective breathlessness during pregnancy. This complicates the diagnosis of true respiratory pathology. “Dyspnea of pregnancy” is likely related to normal physiologic alterations, summarized in Table 26-1, that serve to maintain the fetus and prepare the mother for labor and delivery.1 The dyspnea associated with pregnancy does not interfere with activities of daily living and is not related to exertion, coughing, or wheezing. Physiologic dyspnea usually improves as pregnancy progresses, particularly with “quickening,” which is defined as the maternal perception of initial fetal movement. In contrast, pathologic dyspnea from cardiac or pulmonary origins may have an abrupt onset, be progressive in its severity, occur even at rest, or be associated with cough, chest pain, fever, or hemoptysis. Dyspnea due to cardiac or respiratory pathology worsens as the pregnancy reaches the third trimester. Pregnant women with a respiratory rate greater than 20 breaths/min, increased work of breathing, or the presence of rales, wheezing, or murmurs deserve prompt evaluation for potential cardiopulmonary pathology.2

++
Table Graphic Jump Location
Table 26-1.Physiologic Changes During Pregnancy
++

ACUTE RESPIRATORY FAILURE

++

Epidemiology

++

Acute respiratory failure (ARF) is defined by the inability to maintain adequate oxygenation or ventilation. Although ARF is rare (occurring in less than 0.1% of pregnancies), it remains one of the most common indications for intensive care unit admission in pregnant women.3 The etiology of ARF in pregnancy is diverse and may or may not be directly related to pregnancy (Table 26-2). Acute respiratory distress syndrome (ARDS) has been defined by the American-European Consensus Conference with the following criteria: lung injury of an acute onset, bilateral infiltrates present on chest x-ray, PaO2-to-FiO2 ratio less than or equal to 200, and pulmonary artery wedge pressure less than 18 mm Hg or the absence of clinical evidence of left atrial hypertension.3 The estimated maternal mortality rate due to ARF is reported to be 30% to 35% and, in the setting of ARDS, regardless of the inciting etiology, the mortality rate can be as great as 70%.4 Fetal mortality is also high, most commonly reported at 20% to 30%, and it is usually due to complications from premature delivery or perinatal hypoxia.3

++

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.