Acute respiratory diseases in pregnancy

Abstract

Pregnant women are known to have an increased morbidity and mortality for certain illnesses due to physiological and immunological changes in pregnancy. However, careful attention should be paid to the fetoplacental unit, with delivery generally indicated for obstetric purposes only. Acute respiratory distress syndrome is an uncommon condition in pregnant patients. An essential component in the management of this condition is a perfect coordination between the obstetrician, the pneumologist and critical care specialists. Pregnancy-associated venous thromboembolism consists of deep vein thrombosis and pulmonary embolism occurring during pregnancy or in the postpartum period. This condition is common and is a major source of morbidity in a population which is young and otherwise relatively healthy. Amniotic fluid embolism remains one of the most devastating conditions in obstetrics practice, with reported mortality of 20% to 60%. The treatment is mainly supportive and involves the delivery of the fetus when indicated, respiratory support and hemodynamic support, with the judicious use of fluids, vasopressors, inotropes and, in some cases, pulmonary vasodilators. Respiratory failure complicates a relatively small number of pregnancies, but carries significant potential risks for both mother and fetus. The causes of respiratory failure may be related to pregnancy-specific conditions or other respiratory diseases, and the management requires a multidisciplinary team approach, involving obstetrics, maternal-fetal medicine, neonatology, obstetric medicine, pulmonology and critical care.