Background: Acute respiratory distress in pregnancy is a life-threatening condition which contributes significantly directly or indirectly to maternal death. Case reported: This was that of a 20-year old G1P0+0 who presented with sudden onset of difficulty with breathing with no associated fever, neither cough nor chest tightness at a gestational age of 34weeks+4days having been referred from a private facility where she has had antibiotics and was nebulized without any success. She was not a known asthmatic and laboratory and radiological investigations carried out did not reveal any pathological cause. She was managed as a case of acute respiratory distress due to diaphragmatic compression and was subsequently delivered of a live male neonate who weighed 2.4kg and with good Apgar scores. Mother continued to improve following delivery and was discharged home on the 5th day of admission.

Conclusion: Acute respiratory distress in pregnancy can be due to hormonal changes in pregnancy coupled with diaphragmatic compression from the gravid uterus as the pregnancy advances. A high index of suspicion is required after ruling out pathological causes, this should be followed by immediate delivery to prevent maternal death.