Published: 2017-12-25

Managing dyspnea in pregnancy-an errand uphill: an experience from the critical care obstetric unit of a tertiary care facility in India

Sheeba Marwah, Jyotsana Suri, Pratima Mittal


Background: The occurrence of dyspnea in a gravid woman induces the query in the treating obstetrician regarding its root cause being either underlying or new cardiac or pulmonary disease, or due to the pregnancy itself. Attainment to this conclusion requires grasp of the cardiopulmonary changes befalling during normal pregnancy, as well as detection of the ailment of dyspnea during antenatal period. Objective of present study was to find out the incidence and feto-maternal outcome of patients presenting with dyspnea in pregnancy and puerperium.

Methods: This study was conducted in Department of Obstetrics and Gynaecology in Vardhaman Mahavir Medical College and Safdarjung hospital over a period of one year, wherein review of all women who had presented with a diagnosis of dyspnea in pregnancy and puerperium, and admitted and treated in the Critical care obstetric unit of the department was done. Thorough evaluation was done and case files were exhaustively reviewed, data was anonymously extracted, and outcomes analyzed. All causes of mortality were also recorded. The primary outcome was incidence of dyspnea in pregnancy. Secondary outcomes measured were socio-demographic variables, timing of presentation-antepartum=first trimester, second trimester, third trimester/postpartum<48 hours, 3-7 days,>7 days, causative factors for dyspnea, any other obstetric complications, mode of delivery, fetal outcome (fetus weight, Apgar score, need for NICU admission), need for ICU/HDU admission, duration and course in the hospital, mortality, and cause of death in case of mortality. Data recording was done on a predesigned proforma and deciphered at the end of study and analyzed.

Results: Incidence of dyspnea was 1.97% of all admissions. Pulmonary edema following hypertensive disorders of pregnancy, was the leading cause. 28.5 % women succumbed to their illness. Majority were preterm births (88/112), requiring NICU admission.

Conclusions: The clinician should be able to determine the underlying cause of dyspnea, differentiating it from physiologic progesterone-induced hyperventilation. Strategy of expeditious delivery during the third trimester is often warranted after weighing fetal outcome and maternal risk in such women.


Dyspnea, Causes, Feto-maternal outcome, Pregnancy

Full Text:



Lee SY, Chien DK, Huang CH, Shih SC, Lee WC. Dyspnea in pregnancy. Taiwanese J Obstet Gynecol. 2017;56:432-6.

Graves CR. Acute pulmonary complications during pregnancy. Clin Obstet Gynecol. 2002;45(2):369-76.

Mighty HE. Acute respiratory failure in pregnancy. Clin Obstet Gynecol. 2010;53(2):360-8.

Pandey D, Garg D, Tripathi BN, Pandey S. Dyspnea in pregnancy: an unusual cause. J Basic Clin Reprod Sci. 2014;3(1):68-70.

Mu Y, Mcdonnel N, Li Z, Liang J, Wang Y, Zhu J, et al. Amniotic fluid embolism as a cause of maternal mortality in China between 1996 and 2013: a population-based retrospective study. BMC Pregnancy Childbirth. 2016;16:316.

Hayen A, Herigstad M, Pattinson KTS. Understanding dyspnea as a complex individual experience. Maturitas. 2013;76:45-50.

Rush B, Martinka P, Kilb B, McDermid RC, Boyd JH, Celi LA. Acute respiratory distress syndrome in pregnant women. Obstet Gynecol. 2017;129(3):530-5.

Catanzarite V, Willms D, Wong D, Landers C, Cousins L, Schrimmer D. Acute respiratory distress syndrome in pregnancy and the puerperium: causes, courses, and outcomes. Obstet Gynecol. 2001;97:760-4.

Mabie WC, Barton JR, Sibai BM. Adult respiratory distress syndrome in pregnancy. Am J Obstet Gynecol. 1992;167:950-7.

Schwaiberger D, Karcz M, Menk M, Papadakos PJ, Dantoni SE. Respiratory failure, and mechanical ventilation in the pregnant patient. Crit Care Clin. 2016; 32:85-95.

Catanzarite VA, Willms D. Adult respiratory distress syndrome in pregnancy: report of three cases and review of the literature. Obstet Gynecol Surv. 1997;52:381-92.

ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ 2010;340:c1279.

Cole DE, Taylor TL, McCullough DM, Shoff CT, Derdak S. Acute respiratory distress syndrome in pregnancy. Crit Care Med. 2005;33(suppl):S269-78.

Cugell DW, Frank NR, Gaensler EA, Badger TL. Pulmonary function in pregnancy. I. Serial observations in pregnant women. Am Rev Tuberc. 1953;67:568-97.

Knuttgen HG, Emerson K Jr. Physiological response to pregnancy at rest and during exercise. J Appl Physiol. 1974;36:549-53.

Liberatore SM, Pistelli R, Patalano F, Moneta E, Incalzi RA, Ciappi G. Respiratory function during pregnancy. Respiration. 1984;46:145-50.

El-Khayam U, Gleicher N. Cardiac evaluation during pregnancy. In: Elkhayam U, Gleicher N (eds) Cardiac problems in pregnancy, 3rd ed. Wiley-Liss, New York;1998.

Marwah S, Sharma M, Gaikwad H, Mohindra R. Cardiac disease in pregnancy: still an arduous conundrum for the obstetrician. Int J Reprod Contracept Obstet Gynecol. 2016; 5:1292-9

Marwah S, Topden SR, Sharma M, Mohindra R. Severe Puerperal Sepsis-A simmering menace. J Clin Diagn Res. 2017;11(5):QC04-QC08.

Weinberger SE, Weiss ST, Cohen WR. Pregnancy and the lung: state of the art. Am Rev Repsir Dis. 1980;121:559-81.

Gilroy RJ, Mangura BT, Lavietes MH. Rib cage and abdominal volume displacements during breathing in pregnancy. Am Rev Respir Dis. 1988;137:668-72.

Stenius-Aarniala B, Riikonen S, Teramo K. Asthma and pregnancy: a prospective study of 198 pregnancies. Thorax. 1988;43:12-18.

Schatz M, Harden K, Forsythe A, Chilingar L, Hoffman C, Sperling W et al. The course of asthma during pregnancy, post-partum, and with successive pregnancies: a prospective analysis. J All Clin Immunol. 1988;81:509-17.