The physiologic and hormonal stresses that occur during pregnancy and labor have the potential to worsen existing respiratory disease and can pose unique challenges in management for the obstetrician and obstetric anesthesiologist. Cases of respiratory disease in pregnancy require specific planning and management to optimize maternal and fetal outcome. This chapter discusses rare respiratory disorders that the obstetric anesthesiologist may encounter in practice: acute respiratory distress syndrome, cystic fibrosis, pneumothorax, status asthmaticus, thromboembolic disease, mediastinal mass, congenital central hypoventilation syndrome, pulmonary lymphangioleiomyomatosis, restrictive and interstitial lung disease, transfusion related acute lung injury, transfusion-associated circulatory overload and lung transplantation. The aim is to present relevant discussion in order provide the anesthesiologist with some background and evidence to support her/his decision-making when encountering these rare and challenging cases.

During an obstetrics call duty in your tertiary center, you are called urgently to assist in a Cesarean section of a 42-year-old with sudden intraoperative maternal collapse. Your surgical colleague followed her prenatal care.

Key Learning Points

1. 1. Critical illness in pregnancy is relatively uncommon; however, it carries a significant amount of morbidity and mortality when it does occur. The majority of patients will be admitted to the intensive care unit in the post-partum period.

2. 2. Recent advances in the management of common direct obstetric causes of maternal critical illness have improved outcomes. Unfortunately, however, we have not seen similar advances in treating the indirect causes.

3. 3. Managing this unique cohort of patients is challenging and requires an in-depth knowledge of both maternal physiological adaptations to pregnancy and how these may affect the course of the patient’s illness.

4. 4. In obstetric emergencies, the main priority must be to resuscitate the mother, which, in turn, will help resuscitate the fetus.