DYSPNEA IN PREGNANCY-INCIDENCE AND COMMON CAUSES

Abstract

Objective: To determine incidence of dyspnea in pregnant patients and major underlying causes in these patients and relation of grade of dyspnea and disease with mortality.

Study Design: Prospective cohort study.

Place and Duration of Study: Obstetrics and Gynaecology ward of Armed Forces Institute of Cardiology/ National Institute of Heart Disease (AFIC/NIHD) and Obstetrics and Gynaecology department of Military Hospital Rawalpindi, from Jan 2017 to Jun 2017.

Material and Methods: All patients complaining of dyspnea NYHA II-IV were enrolled from second trimester onwards (>13 weeks). Those undergoing miscarriage, termination of pregnancy and already diagnosed cardiac, pulmonary, thyroid or blood disorders were excluded. Thorough physical examination and laboratory tests to exclude common causes of dyspnea like blood Complete Picture, thyroid function tests, x-ray chest and Echocardiography were done. Patients were followed every month till delivery.

Results: Over all incidence of dyspnea was 40% amongst all obstetric patients. In 35% patients no cause was found and 5% had an underlying cause for dyspnea. Mean age 28.5 ± 5 years, Parity 2 ± 1.4, Period of gestation (POG) at diagnosis was 29.5 ± 3.3 weeks, POG at delivery was 36 weeks ± 1.5 weeks, frequency of NYHA class 2,3,4 was 68%, 28% and 4% respectively. Most common cause of dyspnea was anemia 1050 (87.5%), Cardiac disease 87 (7.2%), pulmonary disease 35 (2.9%) thyroid disease 8 (0.66%) and others 20 (1.66%). Mortality ratio was 220/100,000 live births. Out of mortalities 8% were due to cardiac disease compared to 0.3% due to anemia. All the mortalities were in patients who presented with grade 3 and 4 dyspnea.

Conclusion: Dyspnea should not be ignored as a normal symptom due to pregnancy changes. It could be the sole manifestation of underlying life threatening disease. Some diseases with a high prevalence like anemia can be identified and treated easily during antenatal period. Early recognition and evaluation can save many precious lives.