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Aspiration Pneumonitis Causing Respiratory Collapse in a Pregnant Patient Not in Labor. BACKGROUND: Aspiration is a known risk of obstetric anesthesia; however; it has not been previously described outside of active labor or the setting of anesthesia. CASE: We present the case of a 31-year-old patient with a twin gestation at 33 weeks of gestation, not in labor, with clinically silent aspiration leading to aspiration pneumonitis and respiratory collapse requiring endotracheal intubation and transport to a pulmonary critical care service. After 4 days, she was extubated and eventually underwent a cesarean delivery at 37 weeks of gestation with no long-term pulmonary sequelae. CONCLUSION: Clinicians should consider aspiration pneumonitis in the gravid patient who develops acute shortness of breath, even in the absence of active labor or receipt of anesthesia.