Severe pulmonary edema associated with tocolytic therapy. Case report with hemodynamic study

Œdème pulmonaire aigu lors d’une menace d’accouchement prématuré : rôle de la tocolyse par la nicardipine

Beta adrenergic agonists are still used as first line treatment for preterm labor in many institutions, but their side effects lead to use alternative tocolytic drugs such as calcium channel blockers. We report three cases of pulmonary edema during preterm labor associated with the use of calcium channel blocker, intravenous nicardipine, widely used for tocolysis in France. In this article, potential mechanisms of this severe complication are briefly discussed: pregnancy-induced overload, deleterious hemodynamic effects of calcium channel blockers, concomitant administration of calcium channel blockers and/or beta-agonists and finally concomitant administration of physiological saline and/or glucocorticoids. Based on our experience, we recommend avoiding the association of calcium channel blockers and beta-agonists for preterm labor. Nicardipine, if used, should be administered at an adjusted dose with electric syringe to reduce volume infusion.

Acute pulmonary edema in pregnancy

Pulmonary edema is a secondary disease process characterized by an excess accumulation of fluid in the pulmonary interstitial and alveolar spaces, preventing adequate diffusion of both oxygen and carbon dioxide. The excess fluid accumulation interferes with maternal oxygenation and, if not identified and corrected, can lead to maternal and fetal hypoxemia. The purpose of this article is to review principles of oxygen transport and the pathophysiology, diagnosis, management, and nursing implications of acute pulmonary edema in pregnancy.

The treatment of severe pulmonary edema induced by beta adrenergic agonist tocolytic therapy with continuous positive airway pressure delivered by face mask

IMPLICATIONS

We report the case of a pregnant patient who developed severe pulmonary edema secondary to beta-adrenergic agonist tocolytic therapy (salbutamol) and was successfully treated with mask-delivered continuous positive airway pressure ventilation.