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Managing Respiratory Failure in Late Pregnancy
Kate Williams1, Alastair White1, Melanie Nana2,3
1Critical Care Department, Guys and St Thomas' NHS Trust, London SE1 7EH, UK.
Journal of Clinical Medicine
|May 13, 2026
Summary
Respiratory failure in late pregnancy is high-risk due to physiological changes. Management requires tailored respiratory support and multidisciplinary care, with Extracorporeal Membrane Oxygenation (ECMO) showing improved maternal survival.
Area of Science:
- Critical Care Medicine
- Obstetrics and Gynecology
- Pulmonology
Background:
- Pregnancy involves physiological adaptations that decrease respiratory reserve, increasing risks for respiratory failure.
- Late-gestation respiratory failure poses significant risks due to coupled maternal and fetal outcomes.
- Understanding these physiological changes is crucial for managing respiratory compromise in pregnant individuals.
Purpose of the Study:
- To review the epidemiology, maternal-fetal physiology, and management of respiratory failure in late pregnancy.
- To synthesize current evidence on the causes and clinical implications of respiratory failure during gestation.
- To provide an overview of contemporary management strategies, including ventilatory support and advanced techniques like ECMO.
Main Methods:
- A narrative review approach was employed.
- Integration of contemporary literature, national surveillance data, and physiological principles.
- Incorporation of expert consensus on management strategies.
Main Results:
- Respiratory failure in pregnancy stems from various obstetric and non-obstetric causes (e.g., pneumonia, pulmonary embolism, ARDS).
- Maternal hypoxemia directly correlates with fetal compromise.
- Management necessitates pregnancy-specific ventilation, cautious use of respiratory support (non-invasive, invasive, prone positioning), and consideration of ECMO, with improving maternal survival rates (~75%).
Conclusions:
- Effective management hinges on early recognition, multidisciplinary collaboration, and adapting respiratory support to maternal-fetal physiology.
- Despite advances in critical care and ECMO, significant knowledge gaps remain.
- There is a critical need for integrated maternal critical care pathways and further research to optimize outcomes for both mother and neonate.
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