Acute respiratory distress syndrome in pregnancy and the puerperium: Causes, courses, and outcomes

Objective: To describe causes, courses, complications, and outcomes of pati ents with pregnancy-associated acute respiratory distress syndrome (RDS). Methods: Twenty-eight women with ARDS during pregnancy or within a week pos tpartum formed the study population. Eight cases had been reported previous ly. Charts were abstracted for maternal demographics, etiology, and treatme nt of acute RDS, and maternal outcomes. For antepartum acute RDS, newborn c harts were also reviewed. Results: The incidence of acute RDS, excluding maternal transports, was one per 6277 deliveries or 0.016% (95% confidence interval [CI] 0, 0.027%). Le ading causes were infection (12 cases), preeclampsia or eclampsia (seven ca ses), and aspiration (three cases). Eleven mothers died, a maternal mortali ty rate of 39.3% (CI 21.5%, 59.4%). Six of eight women who were ventilated for over 14 days survived. Nine of the acute RDS cases might have been prev entable. Ten mothers with living fetuses were ventilated during the third t rimester; nine delivered within 4 days. Among six infants delivered because of fetal heart rate abnormalities, one died and at least three had evidenc e of asphyxia. Conclusions: Acute RDS occurs more frequently in pregnancy than the 1.5 cas es per 100,000 per year reported for the general population. Prolonged vent ilator support is warranted. The high rate of perinatal asphyxia in infants who have fetal heart rate abnormalities supports a strategy of expeditious delivery during the third trimester. (Obstet Gynecol 2001;97:760-4. (C) 20 01 by The American College of Obstetricians and Gynecologists.).