51 The Breathless Pregnant Woman

Pregnancy Issues

In most cases breathlessness in pregnancy is due to a normal physiological response2. Pathological causes need to be considered when there is a clinical suspicion.

The risk-benefit ratio of investigations for breathlessness needs to be evaluated. Most radiological investigations expose the woman and baby to radiation, which needs to be minimised, but chest radiography is generally regarded as safe.

In extreme circumstances, in the setting of respiratory failure, whether the woman and baby are sufficiently oxygenated needs to be considered.

Medical Management and Care

• If a pathological cause is suspected the woman needs to be investigated2 and, in particular, conditions that are more common in pregnancy, e.g. pulmonary emboli, need to be considered

• Treatment needs to be specific for the cause of breathlessness but the potential risks of treatment need to be considered, e.g. antibiotic choice for pneumonia

• Details of the management of specific conditions are outlined in the other relevant chapters

Midwifery Management and Care

• The midwifery care needs to be tailored to the woman's needs. This should be focused on education through antenatal care and support for physiological breathlessness. With pathological breathlessness this will involve referral to a consultant obstetrician to assess the woman's case and need for further investigations

• Regular antenatal appointments with the community midwife to ensure that the baby is not compromised and to ensure the woman's health does not deteriorate

• At all stages of pregnancy, whether at the booking visit or mid-trimester the midwife must recognise any complications and give full explanations of these and potential consequences to the mother. This is important in order for her to make informed decisions about where she may want to give birth. If she had intended to give birth at home or in a midwifery-led unit this may not be the most appropriate place

Labour Issues

Breathlessness is very common in labour, but breathlessness in early labour that is not associated with contractions is unusual. This, together with other symptoms or abnormal vital signs should alert the carer to potential pathological causes of breathlessness.

Early referral to a doctor is indicated in the setting of pathological breathlessness because delivery options need review.

Medical Management and Care

• In the setting of pathological breathlessness, augmented labour or early caesarean section may need to be considered

Midwifery Management and Care

• On admission to delivery suite the midwife needs to make an initial assessment of her immediate condition and needs

• This should involve basic observations - recording of maternal pulse, blood pressure, temperature and respiratory rate

• Take a detailed history taking into account any investigations which may recently have been carried out

• Carry out abdominal palpation and auscultation of the fetal heart. If maternal or fetal observations are outside of normal parameters then the midwife should refer to a doctor for further advice. This is also true if the woman has been admitted to a midwifery-led unit or is labouring at home

• If pathological breathlessness is suspected then the baby needs to be continuously monitored with maternal vital signs recorded at more frequent intervals

Postpartum Issues

Breathlessness in the postpartum period is unusual and is likely to reflect a pathological cause such as pulmonary emboli or haemorrhage.

Breathlessness in combination with changes in vital signs is suggestive of a serious complication. The move towards early discharge after delivery places even more importance on the postnatal examination by the midwife in the community.

Medical Management and Care

• Postpartum breathlessness should be taken seriously

• It is important to be mindful of the potential pathological causes of postpartum breathlessness, e.g. pulmonary emboli or anaemia

• A low threshold for seeking further medical advice is required

Midwifery Management and Care

• The midwife needs to be mindful of the potential seriousness of a woman with postpartum breathlessness

• A mother with signs of breathlessness should not be discharged from hospital without having first had a medical review

• Once home, thorough postnatal examinations with astute observation of the physical condition should be conducted. Where necessary instigate appropriate investigations and refer to the primary care physician, or as an emergency to hospital, as warranted

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Responses

  • Adonay
    Why are pregnant women easily breathless?
    8 years ago

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