Skip to main content Accessibility help
  • Print publication year: 2008
  • Online publication date: October 2009

4 - Respiratory disorders in pregnancy

from Section 1 - Cardiovascular and respiratory disorders


Adult respiratory distress syndrome


Adult respiratory distress syndrome (ARDS) is a severe form of acute respiratory failure that can develop following a systemic or pulmonary insult. Adult respiratory distress syndrome is not unique to adults, and in children is known as “acute respiratory distress syndrome”. The incidence of ARDS in pregnancy is variably reported as 1 in 3000 to 1 in 6000 deliveries with mortality as high as 44%.


Several disorders can cause ARDS in pregnancy (see Table 4.1). Sepsis, secondary to pyelonephritis, chorioamnionitis, or endometritis, is a common cause of ARDS in pregnancy. Other causes include obstetric hemorrhage, severe preeclampsia, and aspiration. There may be a combination of sepsis, shock, and fluid overload, the latter of which can be exacerbated by tocolytic therapy.


Following the initial insult, a number of inflammatory mediators such as tumor necrosis factor and interleukins 1, 6, and 8 are released. Neutrophils are activated to release other mediators such as reactive oxygen (O2) species and proteases. These mediators produce widespread microvascular and alveolar epithelial damage. Microvascular damage leads to increased capillary permeability and subsequent interstitial and alveolar edema. Alveolar damage results in loss of surfactant and subsequent alveolar collapse. Alveolar edema and collapse contribute to ventilation–perfusion (V/Q) mismatching and intrapulmonary shunting with subsequent hypoxemia.

Pulmonary hypertension frequently develops leading to right ventricular (RV) dysfunction which reduces left ventricular (LV) preload and cardiac output (CO). Depressed CO further compromises O2 delivery.

Catanzarite, V., Willms, D., Wong, al. Acute respiratory distress syndrome in pregnancy and the puerperium: causes, courses, and outcomes. Obstet. Gynecol. 2001; 97: 760–4.
Perry, K. G. Jr, Martin, R. W., Blake, P. G., Roberts, W. E. & Martin, J. N. Jr.Maternal mortality associated with adult respiratory distress syndrome. South. Med. J. 1998; 91: 441–4.
Mabie, W. C., Barton, J. R. & Sibai, B. M.Adult respiratory distress syndrome in pregnancy. Am. J. Obstet. Gynecol. 1992; 167: 950–7.
Cole, D. E., Taylor, T. L., McCullough, D. M., Shoff, C. T. & Derdak, S.Acute respiratory distress syndrome in pregnancy. Crit. Care Med. 2005; 33: S269–78.
Jenkins, T. M., Troiano, N. H., Graves, C. R., Baird, S. M. & Boehm, F. J.Mechanical ventilation in an obstetric population: characteristics and delivery rates. Am. J. Obstet. Gynecol. 2003; 188: 549–52.
Piantadosi, C. A. & Schwartz, D. A.The acute respiratory distress syndrome. Ann. Intern. Med. 2004; 141: 460–70.
Ware, L. B. & Matthay, M. A.The acute respiratory distress syndrome. N. Engl. J. Med. 2000; 342: 1334–49.
Bernard, G., Artigas, A., Brigham, K. al. The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am. J. Respir. Crit. Care Med. 1994; 149: 818–24.
Marini, J. J. & Gattinoni, L.Ventilatory management of acute respiratory distress syndrome: a consensus of two. Crit. Care Med. 2004; 32: 250–5.
Artigas, A., Benard, G. R., Carlet, al. The American-European consensus conference on ARDS, part 2. Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med. 1998; 157: 1332–47.
Anonymous. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N. Engl. J. Med. 2000; 342: 1301–8.
Taylor, R. W., Zimmerman, J. L., Dellinger, R. al. Inhaled nitric oxide in ARDS study group: low-dose inhaled nitric oxide in patients with acute lung injury: a randomized controlled trial. J.A.M.A. 2004; 291: 1603–9.
Dellinger, R. P., Zimmerman, J. L., Taylor, R. al. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Crit. Care Med. 1998; 26: 15–23.
Bugge, J. F. & Tanbo, T.Nitric oxide in the treatment of fulminant pulmonary failure in a young pregnant woman with varicella pneumonia. Eur. J. Anaesthesiol. 2000; 17: 269–72.
Adhikari, N. & Granton, J. T.Inhaled nitric oxide for acute lung injury: no place for NO?J.A.M.A. 2004; 291: 1629–31.
Spragg, R. G., Lewis, J. F., Walmrath, H. al. Effect of recombinant surfactant protein C-based surfactant on the acute respiratory distress syndrome. N. Engl. J. Med. 2004; 351: 884–92.
Anzueto, A., Baughman, R. P., Guntupalli, K. al. Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group. N. Engl. J. Med. 1996; 334: 1417–21.
Abraham, E., Baughman, R., Fletcher, al. Liposomal prostaglandin E1 (TLC C-53) in acute respiratory distress syndrome: a controlled, randomized, double-blind, multicenter clinical trial. TLC C-53 ARDS Study Group. Crit. Care Med. 1999; 27: 1478–85.
Zeiher, B. G., Artigas, A., Vincent, J. al. Neutrophil elastase inhibition in acute lung injury: results of the STRIVE study. Crit. Care Med. 2004; 32: 1695–1702.
Weidemann, H. P., Fisher, C. J. Jr, Komara, al. Ketoconazole for early treatment of acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. The ARDS Network. J.A.M.A. 2000; 283: 1995–2002.
Bernard, G. R., Wheeler, A. P., Russell, J. al. The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N. Engl. J. Med. 1997; 336: 912–18.
Bernard, G. R., Wheeler, A. P., Arons, M. al. A trial of antioxidants N-acetylcysteine and procysteine in ARDS. The Antioxidant in ARDS Study Group. Chest 1997; 112: 164–72.
Weidemann, H. P., Arrliga, A. C., Komara, al. Randomized, placebo-controlled trial of lisofylline for early treatment of acute lung injury and acute respiratory distress syndrome. The ARDS Clinical Trials Network. Crit. Care Med. 2002; 30: 1–6.
Meduri, G. U., Headley, S., Golden, al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome. A randomized controlled trial. J.A.M.A. 1998; 280: 159–65.
Cunningham, J. A., Devine, P. C. & Jelic, S.Extracorporeal membrane oxygenation in pregnancy. Obstet. Gynecol. 2006; 108: 792–5.
Schultz, M. J., Jonge, E. & Kesecioglu, J.Selective decontamination of the digestive tract reduces mortality in critically ill patients. Critical Care 2003; 7: 107–10.
Catanzarite, V. A. & Willms, D.Adult respiratory distress syndrome in pregnancy :report of three cases and review of the literature. Obstet. Gynecol. Surv. 1997; 52: 381–92.
Chen, C-Y., Chen, P., Wang, K-G., Kuo, S-C. & Su, T-H.Factors implicated in the outcome of pregnancies complicated by acute respiratory failure. J. Reprod. Med. 2003; 48: 641–8.
Sosin, D., Krasnow, J., Moawad, A. & Hall, J. B.Successful spontaneous vaginal delivery during mechanical ventilatory support for the adult respiratory distress syndrome. Obstet. Gynecol. 1986; 68: S19–23.
Daily, W. H., Katz, A. R., Tonnesen, A. & Allen, S. T.Beneficial effect of delivery in a patient with adult respiratory distress syndrome. Anesthesiology, 1990; 72: 383–6.
Kaufman, B. S., Kaminsky, S. J., Rackow, E. C. & Weil, M. H.Adult respiratory distress syndrome following orogenital sex during pregnancy. Crit. Care Med. 1987; 15: 703–4.
Ackerman, W. E., 3rd, Molnar, J. M. & Juneja, M. M.Beneficial effect of epidural anesthesia on oxygen consumption in a parturient with adult respiratory distress syndrome. South. Med. J. 1993; 86: 361–4.
Kwon, H. L., Belanger, K. & Bracken, M. B.Asthma prevalence among pregnant and childbearing-aged women in the United States. Estimates from national health surveys. Ann. Epidemiol. 2003; 13: 317–24.
Stenius-Aarniala, B., Piirila, P. & Teramo, K.Asthma and pregnancy: a prospective study of 198 pregnancies. Thorax 1988; 43: 12–18.
Dombrowski, M. P.Asthma in pregnancy. Obstet. Gynecol. 2006; 108: 667–81.
Clark, S. L.Asthma in pregnancy. Obstet. Gynecol. 1993; 82: 1036–40.
Schatz, M., Dombrowski, M. P., Wise, al. Asthma morbidity during pregnancy can be predicted by severity classification. J. Allergy Clin. Immunol. 2003; 112: 283–8.
Mabie, W. C., Barton, J. R., Wasserstrum, N. & Sibai, B. M.Clinical observations on asthma in pregnancy. Obstet. Gynecol. Surv. 1992; 47: 464–6.
Moore-Gillon, J. C.Pregnancy and the asthmatic (Editorial). Respir. Med. 1991; 85: 451–2.
Dombrowski, M. P.Outcomes of pregnancy in asthmatic women. Immunol. Allergy Clin. North Am. 2006; 26: 81–92.
Bracken, M. B., Triche, E. W., Belanger, al. Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies. Obstet. Gynecol. 2003; 102: 739–52.
Triche, E. W., Saftlas, A. F., Belanger, K., Leaderer, B. P. & Bracken, M. B.Association of asthma diagnosis, severity, symptoms, and treatment with risk of preeclampsia. Obstet. Gynecol. 2004; 104: 585–93.
Lehrer, S., Stone, J., Lapinski, al. Association between pregnancy induced hypertension and asthma during pregnancy. Am. J. Obstet. Gynecol. 1993; 168: 1463–6.
Perlow, J. H., Montgomery, D., Morgan, M. al. Severity of asthma and perinatal outcome. Am. J. Obstet. Gynecol. 1992; 167: 963–7.
Shapiro, D. S. & Owen, C. A.ADAM-33 surfaces as an asthma gene. N. Engl. J. Med. 2002; 347: 936–8.
Tattersfield, A. E., Knox, A. J., Britton, J. al. Asthma. Lancet 2002; 360: 1313–22.
Nelson-Piercy, C.Asthma in pregnancy. Thorax 2001; 56: 325–8.
Schatz, M.The efficacy and safety of asthma medications during pregnancy. Semin. Perinatol. 2001; 25: 145–52.
Gluck, P. A. & Gluck, J. C.A review of pregnancy outcome after exposure to orally inhaled or intranasal budesonide. Curr. Med. Opin. 2005; 21: 1075–84.
Rhen, T. & Cidlowski, J. A.Anti-inflammatory action of glucocorticoids – new mechanisms for old drugs. N. Engl. J. Med. 2005; 353: 1711–23.
National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the diagnosis and management of asthma. NHLBI, NIH Publication No. 97–4051, April 1997.
Dombrowski, M. P., Schatz, M., Wise, al. Randomized trial of inhaled beclomethasone diproprionate versus theophylline for moderate asthma during pregnancy. Am. J. Obstet. Gynecol. 2004; 190: 737–44.
Ducharme, F. M.Anti-leukotrienes as add-on therapy to inhaled glucocorticoids in patients with asthma: systematic review of current evidence. B.M.J. 2002; 324: 1545–63.
National Heart, Lung and Blood Institute: Report of the Working Group on Asthma and Pregnancy: Executive Summary: Management of Asthma During Pregnancy. National Asthma Education Program: NIH publication 93–3279 A, March 1993.
Wendel, P. J., Ramin, S. M., Hamm, C. al. Asthma treatment in pregnancy: a randomized controlled study. Am. J. Obstet. Gynecol. 1996; 175: 150–4.
Braman, S. S. & Kaemmerlen, J. T.Intensive care of status asthmaticus. A 10-year experience. J.A.M.A. 1990; 264: 366–8.
Hirshman, C. A., Kriegler, W., Littlejohn, G., Lee, R. & Julien, R.Ketamine- aminophylline-induced decrease in seizure threshold. Anesthesiology 1982; 56: 464–7.
Pizov, R., Brown, R. H., Weiss, Y. al. Wheezing during induction of general anesthesia in patients with and without asthma. Anesthesiology 1995; 82: 1111–16.
Hagerdal, M., Morgan, C. W., Sumner, A. al. Minute ventilation and oxygen consumption during labor with epidural analgesia. Anesthesiology 1983; 59: 425–7.
Younker, D., Clark, R., Tessem, al. Bupivacaine-fentanyl epidural analgesia for a parturient in status asthmaticus. Can. J. Anaesth. 1987; 34: 609–12.
Collis, R. E., Baxandall, M. L., Srikantharajah, I. al. Combined spinal epidural (CSE) analgesia: technique, management and outcome of 300 mothers. Int. J. Obstet. Anesth. 1994; 3: 75–81.
Mallampati, S. R.Bronchospasm during spinal anesthesia. Anesth. Analg. 1981; 60: 839–40.
Greenberger, P. A. & Patterson, R.Management of asthma during pregnancy. N. Engl. J. Med. 1985; 312: 897–902.
Piggott, S. E., Bogod, D. G., Rosen, al. Isoflurane with either 100% oxygen or 50% nitrous oxide in oxygen for Caesarean section. Br. J. Anaesth. 1990; 65: 325–9.
Rooke, A., Choi, J. H. & Bishop, M. J.The effect of isoflurane, halothane, sevoflurane, and thiopental/nitrous oxide on respiratory resistance after tracheal intubation. Anesthesiology 1997; 86; 1294–9.
Hankins, G. D., Berryman, G. K., Scott, R. al. Maternal arterial desaturation with 15-methyl prostaglandin F2 alpha for uterine atony. Obstet. Gynecol. 1988; 72: 367–70.
Chang, J., Elam-Evans, L. D., Berg, C. al. Pregnancy-related mortality surveillance – United States, 1991–1999. M.M.W.R. 2003; 52 (SS–2); 4.
James, A. H., Jamison, M. G., Brancazio, L. R. & Myers, E. R.Venous thromboembolism during pregnancy and the postpartum period: incidence, risk factors, and mortality. Am. J. Obstet. Gynecol. 2006; 194: 1311–15.
Melis, F., Vandenbrouke, J. P., Buller, H. al. Estimates of risk of venous thrombosis during pregnancy and puerperium are not influenced by diagnostic suspicion and referral basis. Am. J. Obstet. Gynecol. 2004; 191: 825–9.
Polak, J. F. & Wilkinson, D. L.Ultrasonographic diagnosis of symptomatic deep venous thrombosis in pregnancy. Am. J. Obstet. Gynecol. 1991; 165: 625–9.
Gherman, R. B., Goodwin, T. M., Leung, al. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy. Obstet. Gynecol. 1999; 94: 730–4.
Refuzero, J. S., Hechtman, J. L., Redman, M. E. & Whitty, J. E.Venous thromboembolism during pregnancy: clinical suspicion warrants evaluation. J. Reprod. Med. 2003; 49; 767–70.
Lewis, G., Drife, J., Bolting, al. (eds). Why Mothers Die 1997–1999 The Confidential Enquiries into Maternal Deaths in the United Kingdom. London: R.C.O.G. Press, 2001.
Jacob, S., Bloebaum, L., Shah, G. & Varner, M. W.Maternal mortality in Utah. Obstet. Gynecol. 1998; 91: 187–91.
Stirling, Y., Woolf, L., North, W. R. al. Haemostasis in normal pregnancy. Thromb. Haemost. 1984; 52: 176–82.
Norris, L. A., Sheppard, B. L. & Bonnar, J.Increased whole blood platelet aggregation in normal pregnancy can be prevented in vitro by aspirin and dazmergel (UK 38485). Br. J. Obstet. Gynaecol. 1992; 99: 253–7.
Friederich, P. W., Sanson, B. J., Simioni, al. Frequency of pregnancy-related venous thrombembolism in anticoagulant factor-deficient women: implications for prophylaxis. Ann. Intern. Med. 1996; 125: 955–60.
Nelson, S. M. & Greer, I. A.Thrombophilia and the risk for venous thromboembolism during pregnancy, delivery and the puerperium. Obstet. Gynecol. Clin. North Am. 2006; 33: 413–27.
Greer, I. A.Prevention and management of venous thromboembolism in pregnancy. Clin. Chest Med. 2003; 24: 123–37.
Chan, W. S. & Ginsberg, J. S.Diagnosis of deep vein thrombosis and pulmonary embolism in pregnancy. Thromb. Res. 2003; 107: 85–91.
American College of Obstetricians and Gynecologists: Prevention of deep vein thrombosis and pulmonary embolism. October 2001; Practice Bulletin No. 21.
Davis, J. D.Prevention, diagnosis, and treatment of venous thromboembolic complications of gynecologic surgery. Am. J. Obstet. Gynecol. 2001; 184: 759–75.
Chunilal, S. D. & Ginsberg, J. S.Advances in the diagnosis of venous thromboembolism – a multimodal approach. J. Thromb. Thrombolysis 2001; 12: 53–7.
Kearon, C.Diagnosis of pulmonary embolism. C.M.A.J. 2003; 168: 183–94.
The PIOPED Investigators: Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). J.A.M.A. 1990; 263: 2753–9.
Winer-Muram, H. T., Boone, J. M., Brown, H. al. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002; 224: 487–92.
Rosenberg, J. M., Lefor, A. T., Kenien, G., Marrosti, M. & Obeid, A.Echocardiographic diagnosis and surgical treatment of postpartum pulmonary embolism. Ann. Thoracic Surg. 1990; 49: 667–9.
Meaney, J. F., Weg, J. G., Chenevert, T. al. Diagnosis of pulmonary embolism with magnetic resonance angiography. N. Engl. J. Med. 1997; 336: 1422–7.
Bates, S. M. & Ginsberg, J. S.How we manage venous thromboembolism during pregnancy. Blood 2002; 100: 3470–8.
Hunt, B. J., Doughty, H. A., Majumdar, al. Thromboprophylaxis with low molecular-weight heparin (Fragmin) in high risk pregnancies. Thromb. Haemost. 1997; 77: 39–43.
Dolovich, L. R., Ginsberg, J. S., Dpiletos, J. D., Holbrook, A. & Cheah, G.A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism. Arch. Intern. Med. 2000; 160: 181–8.
Greer, I. A.Anticoagulants in pregnancy. J. Thromb. Thrombolysis 2006; 21: 57–65.
Sephton, V., Farquharson, R. G., Topping, al. A longitudinal study of maternal dose response to low molecular weight heparin in pregnancy. Obstet. Gynecol. 2003; 101: 1307–11.
Jones, T. K., Barnes, R. W. & Greenfield, J.Greenfield vena caval filter: rationale and current indications. Ann. Thoracic 1986; 42: S48–55.
Kawamata, K., Chiba, Y., Tanaka, R., Higashi, M. & Nishigami, K.Experience of temporary inferior vena cava filters inserted in the perinatal period to prevent pulmonary embolism in pregnant women with deep vein thrombosis. J. Vasc. Surg. 2005; 41: 652–6.
Declos, G. L. & Davila, F.Thrombolytic therapy for pulmonary embolism in pregnancy: a case report. Am. J. Obstet. Gynecol. 1986; 155: 375–6.
Fagher, B., Ahlgren, M. & Astedt, B.Acute massive pulmonary embolism treated with streptokinase during labor and the early puerperium. Acta Obstet. Gynecol. Scand. 1990; 69: 659–61.
Kramer, W. B., Belfort, M., Saade, G. R., Surani, S. & Moise, K. J. Jr. Successful urokinase treatment of massive pulmonary embolism in pregnancy. Obstet. Gynecol. 1995; 86: 660–2.
Flossdorf, T., Breulmann, M. & Hopf, H. B.Successful treatment of massive pulmonary embolism with recombinant tissue type plasminogen activator (rt-PA) in a pregnant woman with intact gravidity and preterm labour. Intensive Care Med. 1990; 16: 454–6.
Wulf, H.Epidural anaesthesia and spinal haematoma. Can. J. Anaesth. 1996; 43: 1260–71.
Harik, J., Raichle, M. E. & Reis, D. J.Spontaneously remitting spinal epidural hematoma in a patient on anticoagulants. N. Engl. J. Med. 1971; 284: 1355–7.
Horlocker, T. T., Wedel, D. J., Benzon, al. Regional anesthesia in the anticoagulated patient: defining the risks. (The second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg. Anesth. Pain Med. 2003; 28: 172–97.
Handler, J. S. & Bromage, P. R.Venous air embolism during cesarean delivery. Reg. Anesth. 1990; 15: 170–3.
Fong, J., Gadalla, F. & Druzin, M.Venous emboli occurring during cesarean section: the effect of patient position. Can. J. Anaesth. 1991; 38: 191–5.
Karuparthy, V. R., Downing, J. W., Husain, F. al. Incidence of venous air embolism during cesarean section is unchanged by the use of a 5–10 head-up tilt. Anesth. Analg. 1989; 69: 620–3.
Gronert, G. A., Messick, J. M., Cucchiara, R. F. & Michenfelder, J. D.Paradoxical air embolism from a patent foramen ovale. Anesthesiology 1979; 50: 548–9.
Hill, B. F. & Jones, J. S.Venous air embolism following orogenital sex during pregnancy. Am. J. Emerg. Med. 1993; 11: 155–7.
Younker, D., Rodriguez, V. & Kavanagh, J.Massive air embolism during cesarean section. Anesthesiology 1986; 65: 77–9.
Gei, A. F., Vadhera, R. B. & Hankins, G. D.Embolism during pregnancy: thrombus, air and amniotic fluid. Anesthesiol. Clin. North America 2003; 21: 165–82.
Peters, S. G.Mediastinal air-fluid level and respiratory failure. Chest 1988; 94: 1063–4.
Clark, S. L.New concepts of amniotic fluid embolism: a review. Obstet. Gynecol. Surv. 1990; 45: 360–8.
Clark, S. L, Hankins, G. D. V., Dudley, D. A., Dildy, G. A. & Porter, T. F.Amniotic fluid embolism: analysis of the national registry. Am. J. Obstet. Gynecol. 1995; 172: 1158–67.
Malhotra, P., Agarwal, R., Awasthi, al. Delayed presentation of amniotic fluid embolism: lessons from a case diagnosed at autopsy. Respirology 2007; 12: 148–50.
Reis, R. L., Pierce, W. S. & Behrendt, D. M.Hemodynamic effects of amniotic fluid embolism. Surg. Gynecol. Obstet. 1969; 129: 45–8.
Bellar, F. K., Douglas, G. W., Debrovner, C. H. & Robinson, R.The fibrinolytic system in amniotic fluid embolism. Am. J. Obstet. Gynecol. 1963; 87: 48–55.
Moore, J. & Baldisseri, M. R.Amniotic fluid embolism. Crit. Care Med. 2005; 33: S279–85
O'shea, A. & Eappen, S.Amniotic fluid embolism. Int. Anesthesiol. Clin. 2007; 45: 17–28.
Cromey, M. G., Taylor, P. J. & Cumming, D. C.Probable amniotic fluid embolism after first trimester pregnancy termination. J. Reprod. Med. 1983; 28: 209–11.
Mallory, G. K., Blackburn, N., Sparling, J. & Nickerson, D. A.Maternal pulmonary embolism by amniotic fluid. Report of three cases and discussion of the literature. N. Engl. J. Med. 1950; 243: 583–7.
Kanayama, N., Yamazaki, T., Naruse, al. Determining zinc coproporphyrin in maternal plasma – a new method for diagnosing amniotic fluid embolism. Clin. Chem. 1992; 38: 526–9.
Kobayashi, H., Ohi, H. & Terao, T.A simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc alpha 2–6 GalNAc. Am. J. Obstet. Gynecol. 1993; 168: 848–53.
Esposito, R. A., Grossi, E. A., Coppa, al. Successful treatment of postpartum shock caused by amniotic fluid embolism with cardiopulmonary bypass and pulmonary artery thromboembolectomy. Am. J. Obstet. Gynecol. 1990; 163: 572–4.
Weksler, N., Ovadia, L., Stav, A., Luchtman, M. & Ribac, L.Continuous arteriovenous hemofiltration in the treatment of amniotic fluid embolism. Int. J. Obstet. Anesth. 1994; 3: 92–6.
Sprung, J., Cheng, E. Y., Patel, S. & Kampine, J. P.Understanding and management of amniotic fluid embolism. J. Clin. Anesth. 1992; 4: 235–40.
Lindeque, B. G., Schoeman, H. S., Dommisse, G. F., Boeyens, M. C. & Vlok, A. L.Fat embolism and the fat embolism syndrome. A double-blind therapeutic study. J. Bone Joint Surg. 1987; 69: 128–31.
Riska, E. B. & Myllynen, P.Fat embolism in patients with multiple injuries. J. Trauma 1982; 22: 891–4.
ten Duis, H. J., Nijsten, M. W., Klasen, J. H. & Binnendijk, B.Fat embolism in patients with an isolated fracture of the femoral shaft. J. Trauma 1988; 28: 383–90.
Lozman, J., Deno, C., Feustel, P. al. Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long-bone fractures. Arch. Surg. 1986; 121: 992–9.
Jones, M. B.Pulmonary fat emboli associated with acute fatty liver of pregnancy. Am. J. Gastroenterol. 1993; 88: 791–2.
Han, D., Lee, K. S., Franquet, al. Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of image findings. Radiographics 2003; 23: 1521–39.
Caplan, L. M., Miller, S. M. & Patel, K. P. Fat embolism. In: Caplan, L. M. & Miller, S. M. (eds.), Anesthesiology Clinics of North America, Embolism II. Volume II, Number I. New York: W. B. Saunders Co., 1993; pp. 25–54.
Dauphin-McKenzie, M., Gilles, J. M., Jacques, E. & Harrington, T.Sickle cell anemia in the female patient. Obstet. Gynecol. Surv. 2006; 61: 343–52.
Esseltine, D. W., Baxter, M. R. N. & Bevan, J. C.Sickle cell states and the anaesthetist. Can. J. Anaesth. 1988; 35: 385–403.
Dunn, A., Davies, A., Eckert, al. Intraoperative death during Caesarean section in a patient with a sickle-cell trait. Can. J. Anaesth. 1987; 34: 67–70.
American College of Obstetricians and Gynecologists. Preconception and prenatal carrier screening for cystic fibrosis. Clinical and laboratory guidelines. Washington, DC, 2001.
Kotloff, R. M., FitzSimmons, S. C. & Fiel, S. B.Fertility and pregnancy in patients with cystic fibrosis. Clin. Chest Med. 1992; 13: 623–35.
Riordan, J. R., Rommens, J. M., Kerem, B. al. Identification of the cystic fibrosis gene: cloning and characterization of complementary DNA. Science 1989; 245: 1066–73.
Rommens, J. M., Iannuzzi, M. C., Kerem, B. al. Identification of the cystic fibrosis gene: chromosome walking and jumping. Science 1989; 245: 1059–65.
Ratjen, F. & Doring, G.Cystic fibrosis. Lancet 2003; 361: 681–9.
Anonymous. Correlation between genotype and phenotype in patients with cystic fibrosis. The Cystic Fibrosis Genotype–Phenotype Consortium. N. Engl. J. Med. 1993; 329: 1308–13.
McKone, E. F., Emerson, S. S., Edwards, K. L. & Aitken, M. L.Effect of genotype on phenotype and mortality in cystic fibrosis: a retrospective cohort study. Lancet 2003; 361: 1671–6.
Mickle, J. E. & Cutting, G. R.Genotype–phenotype relationships in cystic fibrosis. Med. Clin. North Am. 2000; 84: 597–607.
Chaun, H.Colonic disorders in adult cystic fibrosis. Can. J. Gastroenterol. 2001; 15: 586–90.
Dray, X., Bienvenu, T., Desmazes-Dufeu, al. Distal intestinal obstruction syndrome in adults with cystic fibrosis. Clin. Gastroenterol. Hepatol. 2004; 2: 498–503.
, Schans C., Prasad, A. & Main, E.Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database Syst. Rev. 2000; 2: CD001401.
Cropp, G. J.Effectiveness of bronchodilators in cystic fibrosis. Am. J. Med. 1996; 100: S19–29.
Ramsey, B. W., Pepe, M. S., Quan, J. al. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. N. Engl. J. Med. 1999; 340: 23–30.
Breen, L. & Aswani, N.Elective versus symptomatic intravenous antibiotic therapy for cystic fibrosis. Cochrane Database Syst. Rev. 2001; 4: CD002767.
Fuchs, H. J., Borowitz, D. S., Christiansen, D. al. Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. The Pulmozyme Study Group. N. Engl. J. Med. 1994; 331: 637–42.
Hubbard, R. C., McElvaney, N. G., Birrer, al. A preliminary study of aerosolized recombinant human deoxyribonuclease I in the treatment of cystic fibrosis. N. Engl. J. Med. 1992; 326: 812–15.
Yankaskas, J. R. & Mallory, G. B. Jr.Lung transplantation in cystic fibrosis: consensus conference statement. Chest 1998; 113: 217–26.
Shennib, H., Adoumie, R. & Noirclerc, M.Current status of lung transplantation for cystic fibrosis. Arch. Intern. Med. 1992; 152: 1585–8.
Gyi, K. M., Hodson, M. E. & Yacoub, M. Y.Pregnancy in cystic fibrosis lung transplant recipients: case series and review. J. Cyst. Fibros. 2006; 5: 171–5.
Rosenfeld, M. A. & Collins, F. S.Gene therapy for cystic fibrosis. Chest 1996; 109: 241–52.
Ackerman, M. J. & Clapham, D. E.Ion channels: basic science and clinical disease. N. Engl. J. Med. 1997; 336: 1575–86.
Caplen, N. J., Alton, E. W., Middleton, P. al. Liposome-mediated CFTR gene transfer to the nasal epithelium of patients with cystic fibrosis. Nature Medicine 1995; 1: 39–46.
Cohen, L. F., Agnese, di Sant' P. A. & Friedlander, J.Cystic fibrosis and pregnancy. A national survey. Lancet 1980; 2: 842–4.
McMullen, D. H., Pasta, D. J., Frederick, P. al. Impact of pregnancy on women with cystic fibrosis. Chest 2006; 129: 706–11.
Geddes, D. M.Cystic fibrosis and pregnancy. J. R. Soc. Med. 1992; 85: S36–7.
Odegaard, I., Stray-Pedersen, B., Hallberg, al. Maternal and fetal morbidity in pregnancies of Norwegian and Swedish women with cystic fibrosis. Acta Obstet. Gynecol. Scand. 2002; 81: 698–705.
Gillet, D., Braekeleer, M., Bellis, G. & Durieu, L.Cystic fibrosis and pregnancy. Report from French data (1980–1999). Br. J. Obstet. Gynaecol. 2002; 109: 912–18.
Gilljam, M., Antoniou, M., Shin, al. Pregnancy in cystic fibrosis. Fetal and maternal outcome. Chest 2000; 118: 85–91.
Edenborough, F. P., Mackenzie, W. E. & Stableforth, D. E.The outcome of 72 pregnancies in 55 women with cystic fibrosis in the United Kingdom 1977–1996. Br. J. Obstet. Gynaecol. 2000; 107: 254–61.
Edenborough, F. P., Stableforth, D. E., Webb, A. K., Mackenzie, W. E. & Smith, D. L.Outcome of pregnancy in cystic fibrosis. Thorax 1995; 50: 170–4.
Hardin, D. S., Rice, J., Cohen, R. C., Ellis, K. J. & Nick, J. A.The metabolic effects of pregnancy in cystic fibrosis. Obstet. Gynecol. 2005; 106; 367–75.
Hyde, N. H. & Harrison, D. M.Intrathecal morphine in a parturient with cystic fibrosis. Anesth. Analg. 1986; 65: 1357–8.
Howell, P. R., Kent, N. & Douglas, M. J.Anaesthesia for the parturient with cystic fibrosis. Int. J. Obstet. Anesth. 1993; 2: 152–8.
Novy, M. J., Tyler, J. M., Shwachman, H., Easterday, C. L. & Reid, D. E.Cystic fibrosis and pregnancy. Report of a case with a study of pulmonary function and arterial blood gases. Obstet. Gynecol. 1967; 30: 530–6.
Deshpande, S.Epidural analgesia for vaginal delivery in a patient with cystic fibrosis following double lung transplantation. Int. J. Obstet. Anesth. 1998; 7: 42–5.
Bose, D., Yentis, M. & Fauvel, N. J.Caesarean section in a parturient with respiratory failure caused by cystic fibrosis. Anaesthesia 1997; 52: 578–82.
Sahn, S. A. & Heffner, J. E.Spontaneous pneumothorax. N. Engl. J. Med. 2000; 342: 868–74.
Winter, J. T., Nichols, F. C., 3rd, Pairolero, P. C., Ney, J. A. & Ogburn, P. L. Jr.Management of spontaneous pneumothorax during pregnancy: case report and review of the literature. Mayo Clin. Proc. 1996; 71: 249–52.
Harris, E. A.Tension pneumothorax in a parturient undergoing cesarean delivery. Anesth. Analg. 2000; 90: 1173–4.
Noppen, M., Alexander, P., Driesen, P., Slabbynck, H. & Verstraeten, A.Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am. J. Respir. Crit. Care Med. 2002; 165: 1240–4.
Devanand, A., Koh, M. S., Ong, T. al. Simple aspiration versus chest-tube insertion in the management of primary spontaneous pneumothorax: a systematic review. Respir. Med. 2004; 98: 579–90.
Hwong, T. M., Ng, C. S., Lee, T. al. Video-assisted thoracic surgery for primary spontaneous hemopneumothorax. Eur. J. Cardiothorac. Surg. 2004; 26: 893–6.
Seaton, D., Yoganathan, K., Coady, T. & Barker, R.Spontaneous pneumothorax: marker gas technique for predicting outcome of manual aspiration. B.M.J. 1991; 302: 262–5.
Reid, C. J. & Burgin, G. A.Video-assisted thoracoscopic surgical pleurodesis for persistent spontaneous pneumothorax in late pregnancy. Anaesth. Intensive Care 2000; 28: 208–10.
Levine, A. J. & Collins, F. J.Treatment of pneumothorax during pregnancy. Thorax 1996; 51: 338–9.
Kuczkowski, K. M. & Benumof, J. L.Subglottic tracheal stenosis in pregnancy: anesthetic implications. Anaesth. Intensive Care 2003; 31: 576–7.
Sutcliffe, N., Remington, S. A., Ramsay, T. M. & Mason, C.Severe tracheal stenosis and operative delivery. Anaesthesia 1995; 50: 26–9.
Salama, D. J. & Body, S. C.Management of a term parturient with tracheal stenosis. Br. J. Anaesth. 1994; 72: 354–7.
Ratner, E. F., Cohen, S. E., El Sayed, Y. & Druzin, M.Mask induction with sevoflurane in a parturient with severe tracheal stenosis. Anesthesiology 2001; 95: 553–5.
Chen, M. L. & Keens, T. G.Congenital central hypoventilation syndrome: not just another rare disorder. Paediatr. Resp. Rev. 2004; 5: 182–9.
Paton, J. Y., Swaminathan, S., Sargent, C. W. & Keens, T. G.Hypoxic and hypercapnic ventilatory responses in awake children with congenital central hypoventilation syndrome. Am. Rev. Respir. Dis. 1989; 140: 368–72.
Marazita, M. L., Maher, B. S., Cooper, M. al. Genetic segregation analysis of autonomic nervous system dysfunction in families of probands with idiopathic congenital central hypoventilation syndrome. Am. J. Med. Genet. 2001; 100: 229–36.
Weese-Mayer, D. E., Silvestri, J. M., Huffman, A. al. Case/control family study of autonomic nervous system dysfunction in idiopathic congenital central hypoventilation syndrome. Am. J. Med. Genet. 2001; 100: 237–45.
Sritippayawan, S., Hamutcu, R., Kun, S. al. Mother–daughter transmission of congenital central hypoventilation syndrome. Am. J. Respir. Crit. Care Med. 2002; 166: 367–9.
McLoughlin, L., Thomas, G. & Hasan, K.Pregnancy and lymphangioleiomyomatosis: anesthetic management. Int. J. Obstet. Anesth. 2003; 12: 40–4.
Taylor, J. R., Ryu, J., Colby, T. V. & Raffin, T.Lymphangioleiomyomatosis. Clinical course in 32 patients. N. Engl. J. Med. 1990; 323: 1254–60.
Avila, N. A., Kelly, J. A., Chu, S. C., Dwyer, A. J. & Moss, J.Lymphangioleiomyomatosis: abdominopelvic CT and US findings. Radiology 2000; 216: 147–53.
Wahedna, I., Cooper, S., Williams, al. Relation of pulmonary lymphangioleiomyomatosis to use of oral contraceptive pill and fertility in the UK: a national case control study. Thorax 1994; 49: 910–14.
Johnson, S. R. & Tattersfield, A. E.Decline in lung function in lymphangioleiomyomatosis: relation to menopause and progesterone treatment. Am. J. Respir. Crit. Care Med. 1999; 160: 628–33.
Boehler, A., Speich, R., Russi, E. W. & Weder, W.Lung transplantation for lymphangioleiomyomatosis. N. Engl. J. Med. 1996; 335: 1275–80.
Boggess, K. A., Easterling, T. R. & Raghu, G.Management and outcome of pregnant women with interstitial and restrictive lung disease. Am. J. Obstet. Gynecol. 1995; 173: 1007–14.