Respiratory Distress Syndrome In Pregnancy Research Articles

Acute Respiratory Distress Syndrome in Pregnancy: Updates in Principles and Practice.

Acute respiratory failure occurs in 0.05% to 0.3% of pregnancies and is precipitated by pulmonary and nonpulmonary insults. Acute respiratory distress syndrome (ARDS) is the rapid onset of hypoxemic respiratory failure associated with bilateral pulmonary opacities on chest imaging attributed to noncardiogenic pulmonary edema. The pathophysiological features of ARDS include hypoxemia, diminished lung volumes, and decreased lung compliance. While there is a paucity of data concerning ARDS in the pregnant individual, management principles do not vary significantly between pregnant and nonpregnant patients. The following review will discuss the diagnosis and management of the pregnant patient with ARDS.

Acute Respiratory Distress Syndrome in Pregnancy.

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by several clinical features and pathological responses involving the respiratory system primarily. Infections (viral), sepsis, and massive transfusion are the commonest causes of ARDS during pregnancy. The majority of them recover with noninvasive ventilatory (NIV) support. NIV is safe in pregnancy provided the center is experienced and has a protocolized patient care pathway. Parturients requiring invasive mechanical ventilation are best managed in experienced centers. PaO2/FiO2 targets are higher in parturients compared to nonpregnant patients. Permissive hypercapnia is not a safe option in pregnancy. In severe ARDS with refractory hypoxemia, prone ventilation is a safe option. However, it has to be done in experienced centers. Venovenous ECMO is a safe alternative option in pregnant women with refractory hypoxemia, and delivery has been prolonged to a safe viable age on ECMO. The decision to deliver and the mode of delivery have to be a multidisciplinary decision; primary criterion is maternal survival. Postdelivery, establishing maternal bonding while in ventilatory support facilitates early weaning and minimizes lactation failure.How to cite this articlePandya ST, Krishna SJ. Acute Respiratory Distress Syndrome in Pregnancy. Indian J Crit Care Med 2021; 25(Suppl 3):S241–S247.

Acute Respiratory Distress Syndrome in Pregnancy and Peripartum: Facts and Figures

Acute respiratory distress syndrome (ARDS) is a serious condition occurring rarely during pregnancy and peripartum period. ARDS occurs either due to pregnancy associated risk factors or due to the increased risk during pregnancy. Clinical presentation, arterial blood gas, chest X-ray, and computerized tomography will help in the diagnosis of ARDS. Management of ARDS in pregnancy and peripartum period can be summarized by the “ARDS12,” including lung protective ventilation (lower tidal volume, higher respiratory rate, positive end expiratory pressure titration), negative fluid balance, neuromuscular blocking agents, prone position, use of inhaled nitric oxide, high frequency oscillation ventilation, extracorporeal membrane oxygenation, extracorporeal carbon dioxide removal, use of corticosteroids and continuing the supportive care. Overall morality from ARDS is showing decreasing trends, and the mortality during pregnancy and peripartum period is significantly lower than in general population.

Severe Acute Respiratory Distress Syndrome in Pregnancy. Caesarean Section in the Second Trimester to Improve Maternal Ventilation

We report the case of a 25-year-old woman in the second trimester of pregnancy with acute respiratory distress syndrome associated with miliary tuberculosis. Delivery of the baby by caesarean section at 24 weeks gestation resulted in an immediate and sustained improvement in respiratory function and maternal survival. We believe this to be the first report suggesting a role for caesarean section, performed with the aim of an improvement in maternal respiratory function, at such an early point in pregnancy.

Acute respiratory distress syndrome in pregnancy

To summarize the pathophysiology and treatment of acute lung injury and acute respiratory distress syndrome (ARDS) during pregnancy. Review of select articles from MEDLINE, including published abstracts, case reports, observational studies, controlled trials, review articles, and institutional experience. ARDS occurs in pregnancy and may have unique causes. Despite extensive clinical research to improve the management of ARDS, mortality remains high, and few strategies have shown a mortality benefit. Furthermore, in most published studies, pregnancy is an exclusionary criterion, and thus, few treatments have been adequately evaluated in obstetric populations. The treatment of ARDS in pregnancy is extrapolated from studies performed in the general ARDS patient population, with consideration given to the normal physiologic changes of pregnancy. In general, the best support of the fetus is support of the mother. From the age of viability (24-26 wks at most institutions) until full term, decisions regarding delivery should be made based primarily on the standard obstetric indications. Little evidence exists regarding the management of ARDS specifically in pregnancy, and thus, treatment approaches must be drawn from studies performed in a general patient population. A multidisciplinary approach involving maternal-fetal medicine, neonatology, anesthesiology, and intensivist clinicians is essential to optimizing maternal and fetal outcomes.

Acute Respiratory Distress Syndrome in Pregnancy and the Puerperium

Acute Respiratory Distress Syndrome in Pregnancy and the Puerperium

Acute respiratory distress syndrome in pregnancy and the puerperium: causes, courses, and outcomes

Objective: To describe causes, courses, complications, and outcomes of patients with pregnancy-associated acute respiratory distress syndrome (RDS). Methods: Twenty-eight women with ARDS during pregnancy or within a week postpartum formed the study population. Eight cases had been reported previously. Charts were abstracted for maternal demographics, etiology, and treatment of acute RDS, and maternal outcomes. For antepartum acute RDS, newborn charts were also reviewed. Results: The incidence of acute RDS, excluding maternal transports, was one per 6277 deliveries or 0.016% (95% confidence interval [CI] 0, 0.027%). Leading causes were infection (12 cases), preeclampsia or eclampsia (seven cases), and aspiration (three cases). Eleven mothers died, a maternal mortality rate of 39.3% (CI 21.5%, 59.4%). Six of eight women who were ventilated for over 14 days survived. Nine of the acute RDS cases might have been preventable. Ten mothers with living fetuses were ventilated during the third trimester; nine delivered within 4 days. Among six infants delivered because of fetal heart rate abnormalities, one died and at least three had evidence of asphyxia. Conclusions: Acute RDS occurs more frequently in pregnancy than the 1.5 cases per 100,000 per year reported for the general population. Prolonged ventilator support is warranted. The high rate of perinatal asphyxia in infants who have fetal heart rate abnormalities supports a strategy of expeditious delivery during the third trimester.

Adult Respiratory Distress Syndrome in Pregnancy: Report of Three Cases and Review of the Literature

Adult Respiratory Distress Syndrome in Pregnancy: Report of Three Cases and Review of the Literature

Libman-Sacks endocarditis in a pregnant woman with acute respiratory distress syndrome

Background: Sterile fibrinous vegetations on the mitral valve (Libman-Sacks endocarditis) might be found in one-third of patients with antiphospholipid antibodies. Usually of minor hemodynamic significance, these vegetations might complicate acute respiratory distress syndrome in pregnancy. Case: Despite delivery and aggressive medical therapy, a 17-year-old primigravida with pyelonephritis and acute respiratory distress syndrome suffered rapid decompensation. Echocardiography showed mitral valve vegetations with severe regurgitation. Blood cultures were negative, but antinuclear antibody test and lupus anticoagulant were positive. The patient died of massive cerebral infarction and brainstem herniation. Autopsy found a patent foramen ovale and Libman-Sacks endocarditis. Conclusion: With rapid decompensation of acute respiratory distress syndrome in pregnancy, despite aggressive medical therapy, complicating processes must be considered, especially with antiphospholipid antibodies, which can be associated with sterile heart vegetations and subsequent fatal thromboembolism.

Acute respiratory distress syndrome in pregnancy

Acute respiratory distress syndrome is a serious sequelae of many serious illnesses during pregnancy. An understanding of acute respiratory distress syndrome is central to the proper care of a patient with the disorder. Acute respiratory distress syndrome results in diminished pulmonary compliance and respiratory shunt mediated hypoxemia. Furthermore, the initial pulmonary injury in acute respiratory distress syndrome may be further worsened by therapeutic hyperoxia and barotrauma. Limitation of peak-plateau airway pressure to less than 35 to 40 cm H2O may reduce barotrauma. Inflammatory mediator therapy may hold future promise in attenuation of lung injury induced by acute respiratory distress syndrome. Aggressive care may help those pregnant patients afflicted with acute respiratory distress syndrome.

Staphylococcal septicemia and adult respiratory distress syndrome in pregnancy treated with extra-corporeal carbon dioxide removal: Greenberg L.R.; Moore T.R. USA Obstet Gynecol 1995 86/4 II Suppl. (657–660)

International Journal of Gynecology & ObstetricsVolume 53, Issue 2 p. 213-213 Citations from the literature infectious diseases Staphylococcal septicemia and adult respiratory distress syndrome in pregnancy treated with extra-corporeal carbon dioxide removal Greenberg L.R.; Moore T.R. USA Obstet Gynecol 1995 86/4 II Suppl. (657–660) First published: May 1996 https://doi.org/10.1016/S0020-7292(96)90145-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume53, Issue2May 1996Pages 213-213 RelatedInformation

Staphylococcal septicemia and adult respiratory distress syndrome in pregnancy treated with extracorporeal carbon dioxide removal

Septicemia in pregnancy may take an especially fulminant course. Adult respiratory distress syndrome (RDS) and disseminated intravascular coagulation (DIC) are associated life-threatening complications. Treatment consists of appropriate antibiotic coverage and supportive measures. A previously healthy 21-year-old woman presented at 26 weeks' gestation with staphylococcal sepsis of undetermined origin. Her course was complicated by the rapid onset of adult RDS, DIC, and multi-organ-system failure, resulting in preterm delivery. Despite maximal ventilatory support, her pulmonary status continued to deteriorate. She was treated ultimately with extracorporeal carbon dioxide removal and survived without serious sequelae. Extracorporeal carbon dioxide removal may improve survival in gravidas with adult RDS by decreasing the required airway pressures for ventilation, thus permitting pulmonary recovery.

Adult respiratory distress syndrome in pregnancy

OBJECTIVE: Our objective was to determine the causes of adult respiratory distress syndrome in pregnancy, the treatment required, and maternal and perinatal outcomes. STUDY DESIGN: We examined a case series of 16 patients with adult respiratory distress syndrome initially treated in an obstetric intensive care unit. Criteria for the diagnosis were respiratory distress requiring mechanical ventilation and a lung injury score >2.5. RESULTS: The incidence of adult respiratory distress syndrome in pregnancy was 1 per 2893 deliveries, occurring primarily in the third trimester. The causes were infection ( n = 8), preeclampsia/eclampsia ( n = 4), hemorrhage (I = 2), thrombotic thrombocytopenic purpura ( n = 1), and smoke inhalation ( n= 1). Most patients (69%) were delivered before or soon after admission to our hospital. Multiple organ failure developed in 12 patients (75%). Complications of mechanical ventilation occurred in 81% of cases. Other complications of intensive care unit support were endocarditis, superior vena cava thrombosis, line sepsis, and bacteremia. Maternal mortality was 44%; perinatal mortality was 20%. CONCLUSIONS: Adult respiratory distress syndrome in pregnancy is associated with a maternal mortality similar to that of studies in the nonpregnant patient. The main causes in pregnancy are hemorrhage, infection, and toxemia. All maternal deaths occurred in patients with multiorgan failure. ( Am J Obstet Gynecol 1992;167:950–7.)

Extensive pulmonary embolism presenting as severe adult respiratory distress syndrome after surgical resection of a cornual pregnancy

A rare case of severe adult respiratory distress syndrome associated with a Po2 of 9 mm Hg after surgical resection of a cornual pregnancy at 10 weeks' gestation was treated successfully with positive end-expiratory pressure. The underlying cause, extensive pulmonary embolism, was subsequently revealed. The patient survived without residual brain damage. The possible causes of adult respiratory distress syndrome in pregnancy are discussed.

Pheochromocytoma Associated with Pregnancy: A Case Report

Pheochromocytoma Associated with Pregnancy: A Case Report

Intraamniotic triidothyronine instillation for prevention of respiratory distress syndrome in pregnancies complicated by hypertension.

Respiratory distress syndrome (RDS) is the main cause of death among premature newborn infants [21]. Despite recent improvements in treatment by neonatal intensive care and respiratory assistance, mortality from RDS remains high [20]. Inadequate pulmonary surfactant is thought to be a primary factor leading to the development of RDS [2]· LIGGINS [12] was the first to observe an accelerated lung maturity of fetal lambs treated in utero with glucocorticoids. LIGGINS and HOWIE [14] first reported the beneficial effect of the maternal administration of antepartum glucocorticoid on the incidence of RDS in premature infants. This has since been confirmed by others [3,5,8,18]. However, attention must be drawn to the possibility of an adverse effect of corticosteroid treatment in cases with hypertensionedema-proteinuria syndromes. In this group a significantly higher fetal death rate was observed under betamethasone therapy [13]. Studies indicating a high incidence of RDS in neonatal hypothyroidism [25] suggest the possibility that thyroid hormones may play an important role on fetal lung maturation. Several animal studies have suggested an important influence of thyroid hormones on acceleration of lung maturation and enhancement of surfactant production [22,27]. Curriculum vitae