DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20175837
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

Abstract


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.


Keywords


Dyspnea, Causes, Feto-maternal outcome, Pregnancy

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