Objective: Our objective was to determine the causes of adult respiratory distress syndrome in pregnancy, the treatment required, and maternal and perinatal outcomes.
Study design: We examined a case series of 16 patients with adult respiratory distress syndrome initially treated in an obstetric intensive care unit. Criteria for the diagnosis were respiratory distress requiring mechanical ventilation and a lung injury score > 2.5.
Results: The incidence of adult respiratory distress syndrome in pregnancy was 1 per 2893 deliveries, occurring primarily in the third trimester. The causes were infection (n = 8), preeclampsia/eclampsia (n = 4), hemorrhage (n = 2), thrombotic thrombocytopenic purpura (n = 1), and smoke inhalation (n = 1). Most patients (69%) were delivered before or soon after admission to our hospital. Multiple organ failure developed in 12 patients (75%). Complications of mechanical ventilation occurred in 81% of cases. Other complications of intensive care unit support were endocarditis, superior vena cava thrombosis, line sepsis, and bacteremia. Maternal mortality was 44%; perinatal mortality was 20%.
Conclusions: Adult respiratory distress syndrome in pregnancy is associated with a maternal mortality similar to that of studies in the nonpregnant patient. The main causes in pregnancy are hemorrhage, infection, and toxemia. All maternal deaths occurred in patients with multiorgan failure.