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Excerpt
Approximately one in four patients in this series (24.4 percent) died. ARDS was diagnosed in the antepartum period in more than half of the cases, most often in the third trimester. Affected women had an average age of 24 years, and presented at an average gestational age of 31 1/2 weeks. Patients spent 9 days on average in the intensive care unit setting and 13 1/2 days in hospital. Survival was not predicted by maternal age, gestational age, gravidity, race, or maternal body weight. Hospital time and the PaO2/FiO2 ratio also could not be related to the outcome, but maximal positive end-expiratory pressure was significantly higher in the nonsurvivors (14.6 vs. 10.2 cm water). No relationship was apparent between the cause of ARDS in a given case and the chance of the patient surviving. Four of the five cases associated with preterm labor were complicated by infection (mainly pyelonephritis). The most common immediate causes of death were multisystem organ failure and sepsis. Three of the 10 maternal deaths occurred within 48 hours of admission to intensive care, but 4 occurred more than a week later.
Pregnancy-related ARDS still is a frequently fatal condition; mortality was approximately 25 percent in this series. The specific cause of ARDS does not predict the maternal outcome.
(ARDS is acute respiratory insufficiency caused by pulmonary injury from a variety of sources (trauma, infection, shock, etc.) and manifest by hypoxemia, diffuse interstitial pulmonary infiltrates, and diminished lung compliance. I was a member of the faculty at the University of Colorado Medical Center when Drs. Ashbaugh, Bigelow, and Petty first described ARDS (Lancet 1967;2:377). Before that time, intensive care had not developed to the point that patients often survived the initial insults that trigger ARDS. With more sophisticated resuscitation techniques and improved antibiotic therapy, patients who survived the acute insult lived long enough to develop the pathophysiology of ARDS.
The present study is the largest series published to date of patients with pregnancy-related ARDS from a single tertiary care hospital. The authors reviewed their experience over a 14-year period (1981-1994) with 41 patients, or approximately three patients per year. The incidence of ARDS in their institution is 0.7 per 1000 live births. Ten patients (24 percent) died, but the authors could not identify any risk factors that were predictive of poor maternal outcome.
ARDS is an uncommon complication in obstetric patients. On our obstetric service at the University of North Carolina Hospitals where approximately 2000 deliveries per year occur, 38 patients were admitted to intensive care units over an 8-year period; 10 of these patients had ARDS (approximately 1/1000) (TJ Monaco Jr. et al., South Med J 1993;86:414). In Halifax, Nova Scotia, in a 14-year period during which there were 64,590 deliveries, 7 patients (1/10,000) were admitted to intensive care units with respiratory insufficiency requiring assisted ventilation (TF Basket, J Sternadel, Br J Obstet Gynaecol 1998;105:981). At the Academic Hospital in Pretoria, South Africa, in one year (1996) there were 28 obstetric patients treated for ARDS (7/1000) from a region in which there were 13,429 births (GD Mantel et al.
