ARDS during pregnancy and immediately postpartum - adult respiratory distress syndrome - Tips From O

Date: March, 1991

The adult respiratory distress syndrome (ARDS) is a significant medical problem in young women who are pregnant or immediately postpartum. To identify factors associated with AWRDS in this population, Smith and colleagues retrospectively reviewed the medical records of women with ARDS admitted over a seven-year period to the intensive care unit at an urban teaching hospital. ARDS was defined as acute respiratory failure characterized by hypoxemia, generalized pulmonary infiltrates without cardiac failure and a pulmonary artery wedge pressure of less than 18 mm Hg.

Fourteen cases of ARDS related to pregnancy were identified. The average age of the women was 26 years. Six (43 percent) of the patients had died. In all but three of the 14 patients, ARDS developed in the last trimester of pregnancy. The average length of gestation was 32 weeks in the patients who survived and 26 weeks in the patients who died. In two of the patients who died, alcoholism and diabetes mellitus with hypertension may have contributed to the development of ARDS. Labor difficulties, infections, eclampsia-toxemia and obstetric hemorrhage occurred in nine patients. During emergency cesarean sections, three patients had respiratory problems that may have caused the syndrome.

The average duration of mechanical ventilatory support was 19 to 20 days. In four patients who died but survived past the first few days of hospitalization, the mean duration of mechanical ventilatory support was 30 days. Complications of prolonged mechanical ventilatory support were evident in these patients. Six of the 14 patients experienced barotrauma, with one patient sustaining an irreversible anoxic central nervous system injury. Infections were documented in eight patients (six of the survivors and two of the nonsurvivors); six patients had obstetric foci of infection.

The authors suggest that improved control of sepsis may reduce the clinical impact of ARDS during pregnancy and the immediate postpartum period. (Western Journal of Medicine, November 1990, vol. 153, p. 508.)

COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

 
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