A Prospective Study on Incidence, Causes and Outcome in Women Presenting with Dyspnea in Pregnancy

Abstract

Background: Dyspnea is common during pregnancy. It can be due to the physiological adaptations taking place during pregnancy or due to the existing or newly developed cardiac or respiratory problem during gestation and puerperium. The cause of dyspnea in a gravid woman should be identified and treated accordingly in order to facilitate a favourable outcome for the mother and baby.Objective: To determine the incidence, etiology and feto-maternal outcome of women presenting with dyspnea in pregnancy and puerperium.Methods: This study was conducted in Department of Obstetrics and Gynaecology in Government General Hospital, Kadapa over a period of 6 months, where all women presenting with dyspnea in pregnancy and puerperium, admitted and treated in the Critical care obstetric unit of the department were selected for the study. A complete history and a thorough physical examination were done and the data were recorded and outcomes analysed. The primary outcome recorded was the incidence of dyspnea in pregnancy. The secondary outcomes analysed were the timing of presentation (either in first trimester or second trimester or third trimester or postpartum <48 hours, 3-7 days, >7 days); cause for dyspnea; any other obstetric complications; mode of delivery; need for ICU/HDU admission; duration and course in the hospital; mortality and cause of death in case of mortality and fetal outcome (fetus weight, need for NICU admission). Data was recorded on a proforma and analysed at the end of study.Results: The incidence of dyspnea was 2.6% among all obstetric admissions. Mean age was 25.1 years. 45% of cases presented in the antepartum period with 75% in the third trimester. 55% of cases presented postpartum with all women presenting within first 7 days. Grade 2 dyspnea was seen in majority (59%) followed by grade 3 (29%). Majority (70%) were stable at presentation but 22.5% were critical. 74% cases delivered, out of which 74% by caesarean section and 26% by vaginal delivery. Mean duration of hospital stay was 11.3 days. Severe anemia (27%) was the most common cause followed by severe preeclampsia (22.5%) and CoVID 19 (20%). 5% of women admitted succumbed to pulmonary edema and ARDS. 20% babies needed NICU admission with a mortality rate of 1.3%.Conclusion: Dyspnea in a pregnant woman should not be regarded as physiological always. The cause of dyspnea should be identified and treated accordingly in order to facilitate a favourable outcome for the mother and baby as easily treatable and preventable causes account for most of the cases.