I'm Suffocating: Priorities in Respiratory Collapse for the Obstetric Patient

Pulmonary complications from both obstetrical and nonobstetrical causes contribute to a mortality rate as high as 80% in the pregnant population.  The physiological alterations during pregnancy influence the maternal and fetal outcomes in the patient with pulmonary compromise.  During pregnancy, most pulmonary disorders occur as a consequence of other disease process and include disorders such as pulmonary edema, pulmonary embolus, and amniotic fluid embolus.  Pneumonia of viral and bacterial etiology or as a result of gastric aspiration can occur and could lead to the development of acute respiratory syndrome (ARDS).  Many pulmonary disorders have the same varying symptoms and may require invasive testing to confirm the diagnosis.   The pregnant uterus is a vital source of blood volume during hypovolemic events.  The result is fetal hypoxemia and the initiation of labor.  During this extensive maternal oxygen desaturation and decompensation, the focus is rather on maternal stabilization, which will hopefully enhance fetal stabilization.  It is therefore of the utmost of importance that prompt recognition and treatment is implemented in order to minimize maternal, fetal and neonatal morbidity and mortality. However, evidence based literature regarding management of critical care promoting optimal obstetrical outcomes is very limited. Therefore, a collaborative approach through clinical assessment, critical thinking, and decision making for the care of the patient with respiratory compromise is paramount to increase the likelihood of a positive outcome for the mother and fetus.