Maternal and neonatal outcomes of respiratory failure during pregnancy

Respiratory failure is an outcome from inadequate gas exchange wherein arterial oxygen and carbon dioxide not at normal levels. A drop of oxygen is called hypoxemia while the rise in arterial carbon dioxide is hypercapnia. Respiratory failure includes abnormal blood gases, increased of breathing and increased respiratory rate. In obstetric patients a complicated conditions occurs resulting to various complications and several physiological changes.  That is why risk of complication in pregnancy with respiratory failure considered challenge for positive maternal and neonatal outcomes.

 

Causes in Maternal Respiratory failure

The main causes of respiratory failure were postpartum hemorrhage, peripartum period, preeclampsia and pneumonia during pregnancy. In which the oxygen reserve impairment during pregnancy causes fast desaturation leading to fetal hypoxia. Many of the patients showed improvement after delivery in partial pressure of arterial oxygen. But some exhibited high incidence of neonatal respiratory distress syndrome. Neonatal complications were commonly caused by sepsis and meconium aspiration syndrome as well as impairment in neurological development.

 

Acute respiratory distress syndrome is classified as mild to severe injuries from aspiration, trauma and multiple transfusions. It is also a condition of newborn having dyspnea with cyanosis that is often related to surfactant deficiency. However, preterm infant retinas showed incomplete retinal vascularization. On the other hand obstetric patients showed 74% having maternal respiratory failure complications while 25.4% to non-obstetric patients.

 

Indeed, early delivery might improve maternal oxygenation and reduce mortality rate. However maternal respiratory failure may not always improve after the delivery wherein deleterious sepsis and lung injury persist after delivery. Additionally a detailed examination is needed to follow up the neonates in the future. Using the risk categories whether normal, questionable and abnormal, if the mental developmental index is <70 then the neonates are suspected to have mental retardation.

 

Source: Prepared by Joan Tura from    Journal of the Formosan Medical  Association

Volume 117, Issue 5, May 2018, Pages 413-420