title: Acute respiratory failure in a 35-year-old woman following preterm vaginal delivery.
abstract: A 35-year-old woman, a non-smoker with a normal body mass index, 'felt wheezy' and developed profound hypoxia 30 min after preterm vaginal delivery at 24+ weeks of gestation. She denied other symptoms, had no fever but was tachycardic and tachypnoeic with normal blood pressure. Pulmonary embolism, amniotic fluid embolism, cardiomyopathy, arrhythmias, sepsis and non-cardiogenic pulmonary oedema were considered as differential diagnoses. Chest X-ray showed an increased pulmonary vasculature, but the blood tests, ECG, echocardiogram and CT pulmonary angiogram were essentially normal. She was managed on a high dependency area with high-flow oxygen and intravenous antibiotics. She improved dramatically and the oxygen requirements dropped to 2 L over the next 4 h. It is plausible that this woman had acute non-cardiogenic pulmonary oedema secondary to a combination of risk factors. This case highlights the importance of a methodical and multidisciplinary approach for a prompt diagnosis and successful treatment of an acutely ill parturient.
authors.affiliation: University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: H M
authors.initials: HM
authors.lastname: Bhandari
authors.forename: M
authors.initials: M
authors.lastname: Gorecha
authors.forename: J
authors.initials: J
authors.lastname: Woodman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D002821:Chorioamnionitis; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000009:adverse effects*; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011644:Puerperal Disorders / Q000209:etiology*; D011654:Pulmonary Edema / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D015149:Tocolytic Agents / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D015149:Tocolytic Agents; D008278:Magnesium Sulfate