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Acute respiratory failure during pregnancy and the peripartum period

Authors
Peter F Clardy, MD
Christine C Reardon, MD
Section Editors
Scott Manaker, MD, PhD
Charles J Lockwood, MD, MHCM
David L Hepner, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Fewer than 2 percent of women require admission to an intensive care unit (ICU) during pregnancy or the peripartum period, defined as the last month of gestation or the first few weeks following delivery [1-4]. Among those who are admitted to an ICU, the most common indications are postpartum hemorrhage and hypertensive disorders. Acute respiratory failure is a rare complication of pregnancy.

The clinical presentation, differential diagnosis, most common causes, and management of acute respiratory failure during pregnancy and the peripartum period are reviewed here. Other critical illnesses associated with pregnancy are described separately. (See "Critical illness during pregnancy and the peripartum period".)

CLINICAL PRESENTATION

Patients with acute respiratory failure during pregnancy or the peripartum period generally present with respiratory distress [5-7]. They are typically dyspneic and unable to speak in complete sentences. Confusion, somnolence, agitation, diaphoresis, and/or cyanosis are common.

Most patients are breathing rapidly (tachypnea) and shallowly (small tidal volumes), while using their accessory muscles of respiration. Ausculatory findings vary according to the cause of the acute respiratory failure, but may include crackles, rhonchi, and/or wheezes. Consolidation may be evident, as indicated by bronchophony, egophony, or whisper pectoriloquy.

INITIAL MANAGEMENT

Initial management is the same regardless of the cause of the acute respiratory failure. Supplemental oxygen should be administered. The preferred method of administering the oxygen depends upon the severity of the hypoxemia. For patients with mild hypoxemia, administration via nasal cannula may be sufficient. More severe hypoxemia generally requires administration via a facemask or a nonrebreather mask. Oxygenation should be monitored continuously by pulse oximetry. A reasonable goal for pregnant patients is to maintain the oxyhemoglobin saturation ≥95 percent to optimize the fetal oxygen content. Adequate fetal oxygenation requires a maternal arterial oxygen tension (PaO2) >70 mmHg, which corresponds to an oxyhemoglobin saturation of 95 percent [8].

                 

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Literature review current through: Nov 2016. | This topic last updated: Mon Oct 05 00:00:00 GMT 2015.
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