Dyspnea in Pregnancy 

 

 

Considerations

 

  • Distinguish physiological vs pathological dyspnea

  • Focused differential diagnosis for pathological dyspnea (cardiac vs. respiratory vs. pregnancy-specific)

  • Perform a thorough physical exam & order appropriate investigations (e.g. labs, ECG, echo, PFTs, V/Q scan) 

  • Liaise with internal medicine/obstetrics to diagnose & treat the underlying cause

  • Need for intrapartum invasive monitoring & postpartum monitoring in ICU/high acuity unit

  • Pregnancy considerations (difficult intubation, aspiration, ↓ time to desaturation, aortocaval compression, 2 patients)

 

 

Pathological vs. Physiological Dyspnea 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Differential Diagnosis

 

  • Cardiac:

    • Cardiomyopathy (dilated/hypertrophic/restrictive)

    • Valvular heart disease (AR, AS, MR, MS) 

    • Pulmonary hypertension & RV failure 

    • Cardiac ischemia

    • Congenital heart disease

    • Arrythmias/heart block

    • Pericardial (percarditis/tamponade)

  • Respiratory:

    • Infections

    • Restrictive: interstitial lung disease, cystic fibrosis, neuromuscular disease, scoliosis

    • Obstructive: asthma, COPD

    • Pneumothorax 

    • Anaphylaxis (bronchospasm)

  • Pregnancy-specific:

    • Severe preeclampsia/eclampsia

    • Amniotic fluid embolism 

    • Pulmonary embolism (more common post-partum)

    • Tocolytic induced pulmonary edema

    • Peripartum cardiomyopathy (last month of pregnancy or during first 5 months post-partum)

    • High neuraxial blockade 

  • Others:

    • Anemia 

    • Hypothyroidism 

    • Hepatic dysfunction