Assessment of severe pulmonary disease in pregnancy with Swan-Ganz monitoring. A report of two cases.

Two parturients with severe pulmonary disease had cardiopulmonary hemodynamics assessed by invasive techniques, and vaginal delivery was conducted under continuous epidural anesthesia. Both patients demonstrated hypoxemia (F1O2 = 0.21%) by arterial blood gas analysis. Supplemental oxygen was administered throughout the last trimester of pregnancy. The patient with chronic pulmonary fibrosis had dyspnea at rest prior to pregnancy and delivered a viable, 1,400-gm infant prematurely. She died suddenly three weeks postpartum. The second patient, 41 years old, had a twin gestation. A pneumonectomy had been performed previously for tuberculosis. The patient demonstrated numerous bouts of acute pulmonary embarrassment and pneumonia, developed gestational diabetes and dyspnea late in gestation and spontaneously delivered two viable, 1,600-gm infants prematurely. All did well. Swan-Ganz catheters were used to assess cardiopulmonary hemodynamics in both patients. Epidural anesthesia was used successfully in both.