22 - Breathlessness

Summary

This chapter discusses the implications, diagnostic signs and management strategies for breathlessness during pregnancy. Breathlessness may be a sign of decompensation of underlying heart or lung disorders, therefore requires urgent investigation and appropriate treatment. Conditions that cause breathlessness in pregnancy can be classified into acute, sub-acute and chronic conditions. These patients are best managed by a multidisciplinary team involving obstetricians, anaesthetist and other relevant subspecialities such as obstetric physicians, cardiologists and respiratory physicians. The patient should be ensured with a patent airway, breathing should be monitored and oxygen should be administered if required. In severe acute asthmatic attacks, nebulised salbutamol can be administered along with steroids and intravenous aminophylline if required. Patients are best managed in the intensive care unit if intubation is anticipated. Magnesium sulphate has also been used in severe cases with a return to beta-2-agonist and steroid inhalers when patient becomes stable.