{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:32:58Z","timestamp":1791498778386,"version":"4.3.4"},"reference-count":76,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Respiratory failure in late pregnancy represents a complex and high-risk clinical scenario due to physiological adaptations during pregnancy that reduce maternal respiratory reserve, with tightly coupled maternal and foetal outcomes. This review aims to synthesise current evidence on epidemiology, maternal\u2013foetal physiology, and management strategies for respiratory failure in late gestation. Methods: This narrative review integrates contemporary literature, national surveillance data, physiological principles, and expert consensus to summarise the causes, clinical implications, and management of respiratory failure in pregnancy. Results: Respiratory failure in pregnancy arises from diverse obstetric and non-obstetric conditions, including pneumonia, asthma, pulmonary embolism, cardiogenic pulmonary oedema, and ARDS. Maternal hypoxaemia is strongly associated with foetal compromise. Management requires pregnancy-specific ventilatory targets, avoidance of permissive hypercapnia, cautious use of non-invasive and invasive ventilation, and safe implementation of prone or semi-prone positioning. ECMO use has expanded, with maternal survival improving to approximately 75%, although optimal anticoagulation and timing of delivery remain uncertain. Conclusions: Effective management of respiratory failure in late pregnancy requires early recognition, multidisciplinary coordination, and adaptation of respiratory support to maternal\u2013foetal physiology. Despite improvements in critical care and ECMO outcomes, key evidence gaps persist, underscoring the need for integrated maternal critical care pathways and further research to optimise outcomes for both mother and baby.<\/jats:p>","DOI":"10.3390\/jcm15093449","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T14:35:53Z","timestamp":1777559753000},"page":"3449","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Managing Respiratory Failure in Late Pregnancy"],"prefix":"10.3390","volume":"15","author":[{"given":"Kate","family":"Williams","sequence":"first","affiliation":[{"name":"Critical Care Department, Guys and St Thomas\u2019 NHS Trust, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4987-2504","authenticated-orcid":false,"given":"Alastair","family":"White","sequence":"additional","affiliation":[{"name":"Critical Care Department, Guys and St Thomas\u2019 NHS Trust, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Nana","sequence":"additional","affiliation":[{"name":"Obstetric Medicine Department, Guys and St Thomas\u2019 NHS Trust, London SE1 7EH, UK"},{"name":"Department of Women and Children\u2019s Health, Kings College London, London WC2R 2LS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9311-1196","authenticated-orcid":false,"given":"Catherine","family":"Nelson-Piercy","sequence":"additional","affiliation":[{"name":"Obstetric Medicine Department, Guys and St Thomas\u2019 NHS Trust, London SE1 7EH, UK"},{"name":"Department of Women and Children\u2019s Health, Kings College London, London WC2R 2LS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3983-9055","authenticated-orcid":false,"given":"Luigi","family":"Camporota","sequence":"additional","affiliation":[{"name":"Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Kings College, London WC2R 2LS, UK"},{"name":"Division of Anaesthetics, Pain Medicine and Intensive Care (APMIC), Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK"},{"name":"Critical Care Department, Imperial College Healthcare Trust, Hammersmith Hospital, London W12 0HS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1055\/s-0037-1600909","article-title":"Management of Acute Respiratory Failure in Pregnancy","volume":"38","author":"Lapinsky","year":"2017","journal-title":"Semin. 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