[Puerperal cardiomyopathy and pulmonary edema after cesarean section].
A 26-year-old woman in the thirty-second week of her fifth pregnancy was admitted with diffuse sudden-onset abdominal pain. Examination revealed cervical dilation to 8 cm, a ruptured uterine cerclage and transverse presentation of the fetus, indicating a need for emergency cesarean section, which was performed under uneventful spinal anesthesia. Three days after surgery the patient presented signs consistent with acute pulmonary edema coinciding with blood transfusion. Echocardiography demonstrated left ventricular systolic dysfunction with an ejection fraction of 35%. The diagnosis was peripartum myocardiopathy with acute respiratory insufficiency due to heart failure. Furosemide and captopril were prescribed and the outcome was satisfactory. The discharge echocardiogram showed a left ventricle of normal size and thickness, and the ejection fraction was 55%. Peripartum myocardiopathy is a type of heart failure that develops during the third trimester or during the first six months after delivery, in the absence of signs of ventricular dysfunction or previous heart disease. Based on clinical presentation and echocardiographic findings, we believe that peripartum myocardiopathy was the cause of acute pulmonary edema in this patient.
Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Arrixaca, Murcia.
P
P
Doménech Asensi
J
J
Hernández-Palazón
J A
JA
Tortosa Serrano
S
S
Burguillos López
B
B
Alonso Miranda
D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D000740:Anemia / Q000150:complications / Q000628:therapy; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D001810:Blood Volume; D023802:Cerclage, Cervical; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D005316:Fetal Distress / Q000209:etiology; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007744:Obstetric Labor Complications; D011183:Postoperative Complications / Q000188:drug therapy; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy; D011644:Puerperal Disorders / Q000188:drug therapy; D011654:Pulmonary Edema / Q000188:drug therapy / Q000209:etiology*; D065227:Transfusion Reaction; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000601:surgery; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging