Tag: postpartum

Dyspnea in Pregnancy: Outcome

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Are there any contraindications to physical activity during pregnancy? Several have been outlined by the American College of Obstetricians and Gynecologists and divided into relative and absolute contraindications. Relative refers to those which, under controlled conditions, allow a woman to maintain a moderate program of physical activity. Medical conditions such as hypertension, anemia or blood…

Continue Reading
Dyspnea in Pregnancy: Exercise in Pregnancy

Dyspnea in Pregnancy: Exercise in Pregnancy

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Exercise in Pregnancy Dr. South-Paul and I have been particularly interested in evaluating exercise as a way to decrease the sensation of dyspnea during pregnancy. By comparing normal sedentary pregnant control subjects with pregnant women enrolled in a supervised moderate exercise program, we documented an increase in the recruited tidal volume in the exercised group….

Continue Reading

Dyspnea in Pregnancy: Amniotic fluid embolism

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

How, then, can we anticoagulate when pulmonary embolism has been well documented? I will outline a course, but this is subject to change as we improve our methods or develop newer anticoagulants. Always begin with IV heparin and you can switch to maintenance Coumadin as long as the first trimester has passed. Discontinue Coumadin at…

Continue Reading
Dyspnea in Pregnancy: Primary pulmonary hypertension

Dyspnea in Pregnancy: Primary pulmonary hypertension

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Primary pulmonary hypertension is a disease of young women, usually in their child-bearing years. It carries a very high mortality rate. Patients present with severe dyspnea and syncope, and it has occurred during pregnancy. It is unknown if this is just an association or if pregnancy exacerbates the disease. If one suspects primary pulmonary hypertension,…

Continue Reading

Dyspnea in Pregnancy: Specific Dyspneic Syndromes

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Specific Dyspneic Syndromes With that background, we can now discuss some specific disease states in which dyspnea and hypoxia may be the predominant symptoms and signs. Fortunately, many pulmonary diseases are uncommon in the child-bearing years; but this may change as many women are having children later in life. We may see more pregnancies complicated…

Continue Reading
Dyspnea in Pregnancy: Mechanical load

Dyspnea in Pregnancy: Mechanical load

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Some amount of breathlessness is a normal physiologic response in pregnant patients. It is so common that 60 to 70 percent of the mothers will experience the sensation in the first two trimesters. Why does this dyspnea occur? Is it an increased mechanical load or an altered respiratory sensation secondary to increased progesterone? The mechanical…

Continue Reading
Figure 3. Partition of the increased oxygen consumption in pregnancy among the organs concerned. (From de Swiet M. The respiratory system. In: Hytten FE, Chamberlain G, eds. Clinical physiology in obstetrics. Oxford: Blackwell Scientific Publications, 1980:91. Used by permission.)

Dyspnea in Pregnancy: Incidence of viral infections

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Although infections are not the main topic of today s conference, several infections deserve attention when we are evaluating the dyspnea cough syndrome of pregnancy. The incidence of viral infections is increased in pregnancy. These patients can have tuberculosis or fungal infections, the most dangerous of which is coccidioidomycosis. We must consider the immunologic changes…

Continue Reading
Dyspnea in Pregnancy: Normal Physiology of Pregnancy

Dyspnea in Pregnancy: Normal Physiology of Pregnancy

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Normal Physiology of Pregnancy Before discussing the other dyspneic syndromes of pregnancy, it is helpful to review the normal physiologic changes in the mother and fetus. There are major effects on the cardiovascular system: increased intravascular volume in the mother, which dilutes laboratory values; increased cardiac output throughout gestation; and increased uterine blood flow. There…

Continue Reading

Dyspnea in Pregnancy: Hospital Course

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Hospital Course Dr. South-Rnd: This patient had increasing dyspnea and was admitted to the ICU. She was treated with oxygen by face mask, parenteral aminophyUine and Solu-Medrol, and terbutaline and atropine by nebuli-zation. Within 48 h, her condition had significantly improved. Oral therapy was started, and a therapeutic theophylline concentration was maintained with theophylline (400…

Continue Reading
Figure 1. PA chest film (Nov 2, 1987) shows bilateral parenchymal lower lobe infiltrates.

Dyspnea in Pregnancy: Case Discussion

Category: Pregnancy | Tags: dyspnea, postpartum, Pregnancy, pulmonary, respiratory

Case Discussion Let us now review the chest roentgenograms of this patient. On Nov 2 (Fig 1), she had bilateral infiltrates with blunting of both costophrenic angles. There was also silhouetting of the medial half of the left hemidi-aphragm and increased retrocardiac density. One month later (Fig 2), both infiltrates had improved. The chest roentgenogram…

Continue Reading