The effects of rhinitis, asthma, and acute respiratory distress syndrome as acute or chronic pulmonary conditions during pregnancy

Pulmonary complications from both obstetrical and non-obstetrical causes contribute to a mortality rate as high as 80% in the pregnant population. The effect of numerous mechanical and biochemical physiologic alterations during pregnancy can influence the maternal and fetal outcomes in a woman with a pulmonary complication. Progesterone, the primary hormone of pregnancy, is a respiratory stimulant that enhances carbon dioxide release and alters the maternal pH in favor of releasing oxygen to the fetus. During systemic compromise, which may be experienced as an acute asthmatic attack or respiratory distress syndrome, desaturation and carbon dioxide retention ensue. Under these conditions, the fetus is at risk for perinatal hypoxemia. Although prompt recognition and treatment are important to minimize maternal, fetal, and neonatal morbidity and mortality, evidence-based literature regarding critical care techniques that promote optimal obstetrical outcomes is limited. Therefore, a collaborative approach to the care of these women is warranted. In addition to critical care, emergency medicine, and obstetrical nurses, the medical team may include an obstetrician, a perinatologist, a neonatologist, a pulmonologist, an intensivist, and an immunologist.