Yikes. We have to be very careful in these situations and consider the heath of both the mother and unborn child. A critical question is if the shortness of breath is pregnancy related, not pregnancy related, or from a pre-existing condition.
Pre-existing conditions/Not pregnancy related:
Think about asthma, pneumonia, COPD, and previous cardiac conditions. The clinical manifestations of valvular abnormalities like mitral or aortic stenosis will be accentuated during pregnancy because of an increased cardiac output - normal physiologic changes. You can read more about valvular abnormalities in pregnancy here.
Pregnancy Related Conditions:
Pulmonary Edema: may be secondary to a few things. Eclampsia or Preeclampsia can cause this. Also, think about Pregnancy Associated Cardiomyopathy - this presents at 8 months gestation up to 5 months post partum. Salient features include a reduced left ventricular ejection fraction (less than 45%), the timing when cardiomyopathy develops, and ruling out other etiologies. Finally, tocolytic therapy may be associated with pulmonary edema.
Pulmonary embolism is about 5 times more common during pregnancy. Why? likely from a combination of venous stasis from the gravid uterus intermittently compressing the inferior vena cava, and from alterations of clotting factors (remember Virchow's Triad). Finally, if severe respiratory symptoms develop during labour and delivery, consider an amniotic fluid embolus - which unfortunately tends to be catastrophic.
ACLS guidelines in pregnancy can be found here.
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