Respiratory failure in pregnancy and post partum fortunately is seldom encountered but carries profound implications for survival and health of both mother and fetus/neonate. In the general population, respiratory failure, often initiated by extrapulmonary disease processes, has emerged as a leading cause of death as mortality from many other diseases has been reduced. The same is true for obstetrics.

When respiratory failure occurs after delivery, therapeutic considerations are similar to those for the nonpregnant patient, although causes unique to pregnancy may impact treatment. When respiratory failure occurs during pregnancy, there is potential for dual tragedy. Fetal well being depends on maternal oxygenation, cardiac output, and uteroplacental perfusion. When a maternal condition causes critical deterioration in oxygenation, interventions that improve the maternal condition may adversely impact the fetus. Risk/benefit considerations regarding delivery timing arise and the ability to assess fetal health in utero is often hampered by maternal medical therapies.

In this article, pregnancy-related changes in respiratory function, the physiology of oxygen delivery to the fetus, and available methods for assessing fetal health are reviewed. Extrapulmonary and pulmonary causes of respiratory failure and their treatments in pregnancy and post partum also are discussed.