Management of Acute Chest Syndrome in Pregnant Patients

Initial Management

Immediate oxygen therapy should be administered to achieve arterial oxygen saturation ≥95%, using non-invasive ventilation with PEEP if necessary for severe hypoxemia, as recommended by the American College of Physicians 1

Pregnancy creates additional physiologic stress with increased blood volume, cardiac output, and oxygen demand, which may complicate ACS management, according to the American Thoracic Society 2
Left uterine displacement should be maintained during management to prevent aortocaval compression by the gravid uterus, as suggested by the American Heart Association 3
Continuous monitoring of maternal oxygenation and fetal heart rate is essential, as recommended by the American Heart Association 3
Ventilation volumes may need to be reduced due to the elevated maternal diaphragm in pregnancy, according to the American Heart Association 3

Beta-1 selective blockers are preferred during pregnancy if needed for other indications, as recommended by the European Society of Cardiology 4

Continuous invasive hemodynamic monitoring should be considered in critically ill pregnant patients, as suggested by the American College of Physicians 1

For stable patients with well-controlled condition, spontaneous vaginal birth is preferable, as recommended by the American College of Obstetricians and Gynecologists 1
Planned cesarean section should be considered for critically ill women requiring inotropic therapy or mechanical support, according to the American College of Obstetricians and Gynecologists 1
Epidural analgesia is preferred during labor as it stabilizes cardiac output, as recommended by the American College of Obstetricians and Gynecologists 1
Avoid prolonged bearing down efforts; consider assisted vaginal delivery to shorten the second stage, as suggested by the American College of Obstetricians and Gynecologists 1

Close follow-up is essential as most pregnancy-related complications occur in the first 4 weeks postpartum, as recommended by the American College of Physicians 1