A 12-year-old boy had a three-year history of exercise-induced pain in his limbs; in particular, the shoulders, elbows, and knees were affected. For six months he had also experienced loss of strength. He noted difficulty with walking and cycling and was hardly able to climb stairs. He developed toe walking and complained about an itchy skin rash with focal depigmentation at his neck and trunk, diagnosed as eczema. He did not complain about swallowing difficulty, yet he became cachexic because his nutritional intake was lagging, and he suffered from mood swings.

Previous history was unremarkable. His parents were healthy, as was his older brother.

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.