Keywords
Tocolysis
Acute pulmonary edema
Categories
How to Cite
Abstract
In preterm labor, tocolytics are used to stop uterine contractions and to allow the administration of corticosteroids for fetal lung maturation, nicardipine is a calcium channel blocker increasingly used for this indication. Several adverse effects have been reported during tocolysis using nicardipine, one of the most serious complications is Acute Pulmonary Edema.
We report a case of a parturient who has admitted at 28 weeks of pregnancy for preterm labor and developed a respiratory failure two days following tocolysis with nicardipine. Echocardiography and Computed Tomography Pulmonary Angiography (CTPA) ruled out a pulmonary embolism and a decompensated heart disease. The patient received oxygen therapy and diuresis for Acute Pulmonary Edema with favorable outcomes.
The purpose of this paper is to discuss the risk factors for the occurrence of pulmonary edema after tocolysis, the importance of the etiologic investigation to exclude differential diagnoses and therapeutic options for management of this complication.
References
Johnson A, Townshend P, Yudkin P, Bull D, Wilkinson AR. Functional abilities at age 4 years of children born before 29 weeks gestation. BMJ. 1993; 306:1715-8. https://doi.org/10.1136/bmj.306.6894.1715
Bolden JR. Acute and chronic tocolysis. Clin Obstet Gynecol. 2014 Sep; 57(3):568-78. https://doi.org/10.1097/grf.0000000000000053
Flenady V, Wojcieszek AM, Papatsonis DN, Stock OM, Murray L, Jardine LA, et al. Calcium channel blockers for inhibiting preterm labour and birth. Cochrane Database Syst Rev. 2014 Jun 5 ;( 6):CD002255. https://doi.org/10.1002/14651858.cd002255
Seror J, Lefevre G, Berkane N, Richard F, Bornes M, Uzan S, et al. B- type natriuretic peptide measurement for early diagnosis of acute pulmonary edema during pregnancy. Acta Obstet Gynecol Scand. 2014 Dec; 93(12):1317-9. https://doi.org/10.1111/aogs.12472
Choi HS, Choi H, Han S, Kim HS, Lee C, Kim YY, et al. Pulmonary edema during pregnancy: unilateral presentation is not rare. Circ J. 2002 Jul; 66(7):623-6. https://doi.org/10.1253/circj.66.623
Van Vliet EO, Boormans EM, de Lange TS, Mol BW, Oudijk MA. Preterm labor: current pharmacotherapy options for tocolysis. Expert Opin Pharmacother. 2014 Apr; 15(6):787-97. https://doi.org/10.1517/14656566.2014.889684
King JF, Flenady VJ, Papatsonis DN, Dekker GA, Carbonne B. Calcium channel blockers for inhibiting preterm labour. Cochrane Database Syst Rev. 2003; (1): CD002255. https://doi.org/10.1002/14651858.cd002255
Oei SG. Calcium channel blockers for tocolysis: a review of their role and safety following reports of serious adverse events. Eur J Obstet Gynecol Reprod Biol. 2016 Jun 1;126(2):136–45. https://doi.org/10.1016/j.ejogrb.2006.03.001
Akerman G, Mignon A, Tsatsaris V, Jacqmin S, Cabrol D, Goffinet F. Pulmonary edema during calcium-channel blockers therapy: Role of predisposing or pharmacologic factors? J Gynecol Obstet Biol Reprod. 2007 Jun;36(4):389–392. https://doi.org/10.1016/j.jgyn.2007.03.004
Serena C, Begot E, Cros J, Hodler C, Fedou AL, Nathan-Denizot N, et al. Nicardipine-induced acute pulmonary edema: a rare but severe complication of tocolysis. Case Rep Crit Care. 2014 Aug 19; 2014:242703. https://doi.org/10.1155/2014/242703
Seror J, Lefevre G, Berkane N, Richard F, Bornes M, Uzan S, et al. B- type natriuretic peptide measurement for early diagnosis of acute pulmonary edema during pregnancy. Acta Obstet Gynecol Scand. 2014 Dec;93(12):1317-9. https://doi.org/10.1111/aogs.12472
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2018 Youssef Motiaa et al.
