Chapter 23 – Breathlessness in Pregnancy




Abstract




Key Implications





Chapter 23 Breathlessness in Pregnancy


Amanda Ali and Hassan Shehata




Key Facts


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.


Types




  • 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.



Key Implications




  • 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.



Key Pointers to Specific Conditions




  • 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



Key Diagnostic Signs




  • 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


See Tables 23.1 and 23.2.




Table 23.1 Key features in various causes of breathlessness



























































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



Table 23.2 Key features seen in commonly performed investigations



































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 in OBSTETRICS | Comments Off on Chapter 23 – Breathlessness in Pregnancy
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