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Acute respiratory failure in pregnancy.

H M Hollingsworth1, R S Irwin

  • 1Division of Pulmonary and Critical Care Medicine, University of Massachusetts Medical School, Worcester.

Clinics in Chest Medicine
|December 1, 1992
PubMed
Summary

Acute respiratory failure in pregnancy poses significant risks to mothers and infants. Management focuses on supportive care and addressing underlying causes like ARDS and asthma, while considering maternal-fetal physiology.

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Area of Science:

  • Obstetrics and Gynecology
  • Critical Care Medicine
  • Pulmonology

Background:

  • Acute respiratory failure in pregnancy is a critical concern, contributing to maternal and fetal morbidity and mortality.
  • Common causes include Acute Respiratory Distress Syndrome (ARDS), venous air embolism, beta-adrenergic tocolytic therapy, asthma, thromboembolic disease, pneumothorax, and pneumomediastinum.
  • Predisposing conditions for ARDS in pregnancy include sepsis, pneumonia, aspiration, and amniotic fluid embolism.

Purpose of the Study:

  • To review the causes, pathophysiology, and management of acute respiratory failure in pregnant individuals.
  • To highlight the importance of understanding maternal-fetal physiology in managing these conditions.
  • To discuss preventative strategies for specific causes of respiratory failure.

Main Methods:

  • Literature review of causes and management strategies for acute respiratory failure in pregnancy.
  • Discussion of the pathophysiology of ARDS, including inflammatory mediators and complement activation.
  • Emphasis on supportive care and treatment of underlying conditions.

Main Results:

  • Treatment is primarily supportive, involving mechanical ventilation, hemodynamic support, nutrition, and thromboembolism prophylaxis.
  • No specific ARDS therapy is proven effective beyond treating the root cause.
  • Asthma-related respiratory failure requires aggressive bronchodilator and corticosteroid therapy, potentially including magnesium sulfate and advanced ventilation.

Conclusions:

  • Management requires a comprehensive approach, integrating critical care principles with obstetric considerations.
  • Preventative measures targeting aspiration, tocolytic therapy, and thromboembolism are crucial.
  • Further research may explore novel therapeutic options for ARDS in pregnancy.

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