[Non-invasive ventilation for pulmonary edema associated with tocolytic agents during labour for a twin pregnancy].
OBJECTIVE
To describe the efficacy and patient acceptance of non-invasive ventilation for pulmonary edema associated with administration of tocolytic drugs during labour of a twin pregnancy.


METHODS
We report the case of a 31-yr-old parturient at 34 weeks gestation of a twin pregnancy, who experienced acute pulmonary edema after tocolytic treatment with nifedipine, nicardipine and atosiban of > 48 hr in duration. This patient presented with hypoxia during labour and non-invasive ventilation was successfully used allowing delivery by vaginal approach, with patient-controlled epidural analgesia, of two twins with a five minute Apgar score of 8. Investigations showed acute pulmonary edema and important transudate pleural effusions with left ventricular systolic dysfunction induced by calcium-antagonist, with favourable outcome after symptomatic treatment.


CONCLUSIONS
When pulmonary edema occurs during pregnancy, non-invasive ventilation could be an efficacious treatment, this avoiding tracheal intubation and its complications.
Perbet
Sébastien
S
Département d'Anesthésie et de Réanimation, Hôtel-Dieu, Centre Hospitalier Universitaire de Clermont-Ferrand, Boulevard Léon-Malfreyt, 63058 Clermont-Ferrand Cedex 1, France. sperbet@chu-clermontferrand.fr
Constantin
Jean-Michel
JM
Bolandard
Franck
F
Vignaud
Marie
M
Gallot
Denis
D
Chanséaume
Sylvain
S
Zénut
Marie
M
Bazin
Jean-Etienne
JE
D000328:Adult; D001034:Apgar Score; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009529:Nicardipine / Q000009:adverse effects; D009543:Nifedipine / Q000009:adverse effects; D010996:Pleural Effusion / Q000188:drug therapy; D011247:Pregnancy; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000628:therapy*; D012121:Respiration, Artificial; D015149:Tocolytic Agents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014427:Twins; D014668:Vasotocin / Q000009:adverse effects / Q000031:analogs & derivatives
D015149:Tocolytic Agents; C047046:atosiban; D009529:Nicardipine; D009543:Nifedipine; D014668:Vasotocin