Factors implicated in the outcome of pregnancies complicated by acute respiratory failure

To investigate factors predictive of the outcome of acute respiratory failure during pregnancy.

We retrospectively reviewed the records of all pregnant women diagnosed with acute respiratory failure at a tertiary referral center from January 1, 1995, to September 30, 2000. Maternal characteristics, etiology of respiratory failure and treatment were compared between survivors and nonsurvivors.

Twenty patients with acute respiratory failure were identified; 16 of them survived (mortality, 20%). Acute respiratory failure was diagnosed in the postpartum period in 16 (80%), and the majority of cases occurred in the first 2 postpartum days (93.8%). There was no statistically significant difference between the 2 groups in terms of patient characteristics, immediate precipitants of acute respiratory failure (including pneumonia, cardiogenic pulmonary edema, acute respiratory distress syndrome, asthma, pulmonary embolism and amniotic fluid embolism) and laboratory characteristics except for pH. However, patients who manifested disseminated intravascular coagulopathy (DIC) and sepsis as precipitating causes or complications of the immediate precipitating disease entities as well as initial loss of consciousness were predictive of poor maternal outcome.

The immediate etiology of acute respiratory failure is not predictive of maternal outcome, but lower pH, initial loss of consciousness, DIC and sepsis are risk factors for maternal mortality.