Chapter 23 – Breathlessness in Pregnancy

Abstract

Key Implications

Amanda Ali and Hassan Shehata

Definition Breathlessness or dyspnoea is the subjective sensation of shortness of breath or difficulty in breathing.

It is very common in pregnancy, with the majority of women experiencing breathlessness at some time during their pregnancy.

Physiological: This is an isolated symptom which occurs as a result of the physiological hyperventilation of pregnancy, leading to a subjective feeling of shortness of breath. It is very common in the third trimester and occurs at rest or while talking and may improve during mild activity.
Pathological: This type of breathlessness occurs in conjunction with other symptoms of cardiorespiratory disease. It is persistent and interferes with daily activities.

Incidence Breathlessness occurs in up to 75% of pregnant women and reaches its maximum incidence in the third trimester.

Maternal: Breathlessness may be a sign of decompensation of underlying heart or lung disease and therefore requires assessment and appropriate management.
Fetal: Chronic hypoxia increases the risk of preterm birth, fetal growth restriction and intrauterine fetal death.

Pulmonary embolism (PE): Deep vein thrombosis (DVT), prolonged bed rest, thrombophilia, venous stasis, recent long-haul air flight, age, parity, increased weight and recent surgery
Pneumonia: Smoking, upper respiratory tract infection (URTI), immunosuppression, drugs, for example, steroids, chronic lung disease, recent hospitalisation or surgery
Asthma: Exercise, stress, emotion, wheeze, cold air, acid reflux, polyarteritis nodosa, vasculitis, eczema and other atopic diseases
Cardiac failure: Exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough, wheeze and peripheral oedema

Pulmonary embolism: Leg swelling, low grade fever, hypotension, tachycardia, tachypnoea and cyanosis
Pneumonia: Fever, tachycardia, cyanosis, productive cough, tachypnoea and rhonchi
Asthma: Tachypnoea, tachycardia, cyanosis, polyphonic wheeze, hyperinflation, diminished air entry or silent chest
Cardiac failure: Raised jugular venous pressure (JVP), cyanosis, hypotension, tachycardia, gallop rhythm, narrow pulse pressure, pleural effusion, bibasal crepitations, wheeze, tachypnoea, cardiomegaly and hepatomegaly

Symptom/sign	Cardiac failure	Asthma	Pulmonary embolism	Pneumonia
Cough	Nocturnal	Nocturnal	Dry	Productive
Abdominal pain	—	—	+	+/−
Lungs	Bibasal crepitations	Expiratory rhonchi ↓ air entry/silent chest	—	Rhonchi
Heart sounds	Gallop rhythm	—	3rd HS	—
Blood pressure	Low	—	↓ /N	—
Pulse	↓ Volume, pulsus alterans	Pulsus paradoxus	N	N
Pulse rate	↑	↑ /N	↑ /N	↑ /N

Investigation	Cardiac failure	Asthma	Pulmonary embolism	Pneumonia
Chest radiograph	Hilar shadowing, Kerley B lines, cardiomegaly, pleural effusion	Hyperinflated lungs	Wedge-shaped opacity, pleural effusion, atelectasis, areas of translucency in underperfused lung	Patchy/consolidation
Electrocardiography	Left ventricular strain/enlargement	N	Right axis deviation, right bundle branch block, peaked waves in lead II, S1 Q3 T3 pattern	N
Echocardiogram	Cardiomegaly, ↓ ejection fraction, +/− valve abnormality valve abnormally	N	Right-sided strain	N

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May 9, 2021 | Posted by drzezo in OBSTETRICS | Comments Off