This document discusses shortness of breath during pregnancy. It begins by noting that shortness of breath is common in pregnancy, occurring in about three quarters of women, especially in the first and third trimesters. It then explains the physiological reasons for shortness of breath in pregnancy, such as increased blood volume and the uterus pushing up on the diaphragm. The document differentiates between physiological and pathological causes. It provides tips for easing shortness of breath during pregnancy and signs that warrant a medical evaluation. The document concludes that distinguishing normal from abnormal shortness of breath is important for diagnosis and management.

1. SHORTNESS OF BREATH
DR ALKA MUKHERJEE
MBBS DGO FICOG FICMCH PGDCR PGDMLS
MA(PSY)
Dr Alka Mukherjee Nagpur 1

2. INTRODUCTION
• The symptom of shortness of breath is quite common
during pregnancy
• It occurs in about three quarters of pregnant women. It
can occur in any trimester of pregnancy
• More common in first trimester and late pregnancy.
• It can be very scary when it occurs for the first time .
• It makes her feel winded and as though one cannot
catch ones breath.
• It is a disturbing and unpleasant experience
• May need to seek help in an emergency.
Dr Alka Mukherjee Nagpur 2

3. PHYSIOLOGY OF NORMAL PREGNANCY
• Progesterone hormone during pregnancy makes breathing
more thoracic and deep , keeping the rate same and that
woman feel breathless
• During pregnancy , there is an increase in blood volume and
cardiac output .
• The size of uterus with baby pushes diaphragm upwards
which presses onto lungs which adds to the feeling of
breathless.
• Taking the stairs may be uncomfortable but it is harmless and
normal .
• Breathlessness in late pregnancy may last until the presenting
part engages and post – delivery , it may take few weeks
before the breathing pattern returns to normal.
Dr Alka Mukherjee Nagpur 3

4. DYSPNOEA IN PREGNANCY
• The mechaism of dyspnoea in pregnancy is controversial
. initially, breathlessness was attributes to an increased
mechanical load by chest wall distortion from the gravid
uterus. However , dysponoea can begin before any
upwards displacement of the diaphragm , suggesting
that factors other then mechanical pressure may be
involved . other studies supports that
• Physiogical dyspnoea is due to a change in preception of
normal respiration .
• Finally dyspnoea probably result from the subjective
awareness of hyperventilation that is universally present
in pregnancy .
Dr Alka Mukherjee Nagpur 4

5. • Hyperventilation in pregnancy is predominantly
due to an increase in the depth of the tidal
volume , with little change in the respiratory rate
• The mechanism of hyperventilation responsible
for the sensation of dyspnoea is not clear but is
attributed to the effect of progesterone on
respiratory netural drive or increased
chemosensititivity to CO2 and hypoxia
• ? Role of psychological , environmental and
sociological factors
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6. AETIOLOGY
• Physiological
• Over distention of the uterus
• - Multiple pregnancy / Polyhydramnios / big baby
• Excessive weight gain
• Anaeima
• Respiratory disease
• - Asthma , bronchitis , pneumonia , tuberculosis
• Cardiac disorders
• - Valvular disease , cardiomyopathy , myocardial infarction
• Embolism – amniotic fluid / pulmonary
• Sepsis
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7. STEPS TO EASE BREATHING DURING
PREGNANCY
• Good posture
• Antenatal exercises
• Yoga – Lift arms to reduce pressure on rib cage ,
breathing exercises
• Relax body when it needs it, slow down , pay attention
to the body’s limits
• Sleep propped up
• Healthy diet , enough water intake
• Avoid excessive weight gain during pregnancy.
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8. TO REPORT TO HOSPITAL IF
• Sudden / severe shortness of breath
• Chest pain
• Palpitations – increase in pulse
• Feeling dizzy / fainting attacks
• Blue lips / nails / extremities
• Persistent cough , hemoptysis , fever worsening
asthma
• Anemia - Bleeding
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9. MANAGEMENT
• If a pregnant patient with history of severe shortness of
breath come to hospital
• Admit the patient – emergency ward / ICU as
appropriate
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10. History
• Take a detailed history from patient / relative
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11. OBSTETRIC
• Duration of amenorrhea / weeks of gestation
• Bleeding – Severity , duration
• Accompanying pain in abdomen
• Fainting attacks / fall – trauma
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12. MEDICAL HISTORY
• Cough / cold / fever / haemoptysis / Koch’s
• Know case of asthma / allergic bronchitis –
taking Rx – medications , puffs
• Known case of rheumatic valvular heart disease
– on Rx / surgery +/ -
• History of previous allergies to any medications
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13. EXAMINATION
• Vital parameters - tachycardia / hypotension + /
RR / pallor / cyanosis.
• Obstetric Examination
• Determine weeks of gestation and foetal
viability
• Rule out spontaneous preterm labour.
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14. INVESTIGATIONS
• Haemogram
• Renal function test
• Liver function test
• Coagulation profile
• Serum electrolytest
• Blood group
• Disseminated intravascular coagulation profile
• Fever profile
• C – reactive protein
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15. • ECG / X –ray chest – if needed (abdominal shield /
portable)
• 2D echo
• Arterial blood gases
• Pulse oximetry
• Spirometry
• Sputum for bacteriology
• Portable ultrasound – obstetric and abdominal
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16. TREATMENT
• Multidisciplinary approach – intensivist / cardiologist / chest
physician
• Propped up position with nasal oxygen
• Maintain airways
• Monitor breathing – vital parameters
• Pulse oximeter
• IV access – fluids / monitor urine output
• Correct anemia /DIC
• Pulmonary cause – infection (IV antibiotics)
• Asthma –Beta 2 agonists , inhalers , puffs , IV steroids if
necessary
• Embolism – Patient survives phase I – anticoagulation with IV
heparin
• Obstetric management – depending upon the cause
• Treatment of preterm labour , if applicableDr Alka Mukherjee Nagpur 16

17.  Physiological - Occur at any stage common in the last
trimester - Only by exclusion
 Anemia - Symptoms present only if severe lethargy,
malaise , etc. - Blood count
 Asthma – Cough - wheeze + /night time / walking -
Auscultation pulmonary function test
 Pulmonary embolism - Sudden – chest pain –
tachycardia High degree of suspicion needed - ECG ,
chest X –ray , arterial blood gases
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DIFFERENTIAL DIAGNOSIS, IMPORTANT CLINICAL
FEATURES, INVESTIGATIONS

18. DIFFERENTIAL DIAGNOSIS, IMPORTANT CLINICAL
FEATURES, INVESTIGATIONS
 Cardiac – Rheumatic cardiomyopathy -Dyspnea in
different positions , tachycardia , pulmonary oedema -
ECG , 2D echo , chest X – ray
 Pneumonia - Productive cough , fever - Chest X – ray ,
complete blood count , sputum
 Pneumothorax - Sudden chest pain – breathlessness -
Chest X –ray
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19. CONCLUSION
• Dyspnea is a common complaint during pregnancy.
• Knowledge of the compensatory mechanisms in pregnancy
and differentiating the etiopathogenesis is must to make the
distinction between a normal physiological change and a
pathological presenting complaint which may mask
significant underlying disease.
• Once this distinction has been made , a combined
multidisciplinary diagnostic and treatment approach with
directed investigations and referral to a tertiary care centre
with such facilities will go a long way towards ameliorating
this vexing condition.
• With timely intervention , most patients will make an
excellent recovery in the absence of any grave cardiac or
pulmonary pathology
Dr Alka Mukherjee Nagpur 19

20. THANK YOU
Dr Alka Mukherjee Nagpur 20