Document Detail

Acute respiratory failure in pregnancy.
MedLine Citation:
PMID:  1362144     Owner:  NLM     Status:  MEDLINE    
Acute respiratory failure in pregnancy is an important cause of maternal and fetal morbidity and mortality. Causes include: ARDS, venous air embolism, beta-adrenergic tocolytic therapy, asthma, thromboembolic disease, pneumothorax, and pneumomediastinum. The most common predisposing diseases for ARDS complicating pregnancy are sepsis, pneumonia, aspiration of gastric contents, and amniotic fluid embolism. Knowledge of normal maternal-fetal physiology and determinants of fetal oxygen delivery (uterine blood flow, placental transfer, fetal circulation) can help sustain normal fetal development, usually without compromising maternal care. The increased microvascular permeability seen in ARDS is likely mediated by neutrophils, proinflammatory mediators (e.g., tumor necrosis factor, interleukin-1, arachidonic acid metabolites) and activation of the complement cascade. Treatment of respiratory failure in pregnancy is largely supportive, including mechanical ventilation, hemodynamic support, nutrition, and prophylaxis against thromboembolism. No specific therapy has as yet been proven effective for ARDS, other than treating the underlying cause. Respiratory failure from status asthmaticus is treated with vigorous bronchodilator therapy, high-dose glucocorticosteroids, magnesium sulfate, and careful ventilator management. Occasionally, more experimental therapies (e.g., isoproterenol infusion, halothane anesthesia) are indicated. Certain strategies can help prevent respiratory failure from aspiration of gastric contents, beta-adrenergic tocolytic therapy, and thromboembolic disease.
H M Hollingsworth; R S Irwin
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinics in chest medicine     Volume:  13     ISSN:  0272-5231     ISO Abbreviation:  Clin. Chest Med.     Publication Date:  1992 Dec 
Date Detail:
Created Date:  1993-02-11     Completed Date:  1993-02-11     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  7907612     Medline TA:  Clin Chest Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  723-40     Citation Subset:  IM    
Division of Pulmonary and Critical Care Medicine, University of Massachusetts Medical School, Worcester.
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MeSH Terms
Acute Disease
Adrenergic beta-Antagonists / adverse effects
Asthma / complications
Diagnosis, Differential
Embolism, Air / complications,  therapy
Fetus / physiology
Mediastinal Emphysema / complications
Oxygen / blood
Pneumonia, Aspiration / complications,  therapy
Pneumothorax / complications
Pregnancy Complications* / diagnosis,  etiology,  therapy
Respiratory Distress Syndrome, Adult / complications,  therapy
Respiratory Insufficiency* / diagnosis,  etiology,  therapy
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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