Pulmonary complications in pregnancy: Emboli and other diseases

Pulmonary embolism (PE) and amniotic fluid embolism are uncommon complications during pregnancy, but they nonetheless require rapid diagnosis and treatment because of their high mortality rates. Heparin is the treatment of choice for PE, and prophylactic heparin is indicated for women who had PE during a previous pregnancy. Low molecular weight heparin is a safe and effective alternative to unfractionated heparin. Women with amniotic fluid embolism typically present with sudden dyspnea and hypotension. The mortality rate is 50% to 60% within 1 hour of the onset of symptoms. Women who have cystic fibrosis or pulmonary lymphangioleiomyomatosis often experience a decline in pulmonary function during pregnancy, while those with sarcoidosis may show improvement. Regardless of the pulmonary disorder, the goal is to avoid hypoxemia, which can result in profound adverse maternal and fetal effects.