Acute Respiratory Failure in the Peripartum Period

Often clinicians are faced with a patient in the peripartum period with acute hypoxemic respiratory failure and a diffuse infiltrate on chest x-ray. As in other patient populations, the approach to these patients includes supportive care, often with intubation and mechanical ventilation, followed by pulmonary artery catheterization to distinguish high versus low pressure pulmonary edema. However, the differential diagnosis in this scenario is slightly different. A specific history of tocolytic use should be sought. Respiratory failure during or immediately after labor should raise the suspicion of amniotic fluid embolism. Echocardiography should be done early to exclude a peripartum cardiomyopathy. A careful search for infection should be performed given the increased propensity to ARDS in response to sepsis. Finally, a history of witnessed aspiration events should be sought.