title: Nicardipine-induced acute pulmonary edema: a rare but severe complication of tocolysis.
abstract: We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.
authors.affiliation: Service d'Anesthésie-Réanimation, Hôpital Mère Enfant, 08 avenue Dominique Larrey, 87000 Limoges, France ; Service de Réanimation Polyvalente, CIC 0801, CHU Dupuytren, 02 avenue Martin Luther King, 87000 Limoges, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Serena
authors.affiliation: Service de Réanimation Polyvalente, CIC 0801, CHU Dupuytren, 02 avenue Martin Luther King, 87000 Limoges, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Begot
authors.affiliation: Service d'Anesthésie-Réanimation, Hôpital Mère Enfant, 08 avenue Dominique Larrey, 87000 Limoges, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cros
authors.affiliation: Service d'Anesthésie-Réanimation, Hôpital Mère Enfant, 08 avenue Dominique Larrey, 87000 Limoges, France ; Service de Réanimation Polyvalente, CIC 0801, CHU Dupuytren, 02 avenue Martin Luther King, 87000 Limoges, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Hodler
authors.affiliation: Service de Réanimation Polyvalente, CIC 0801, CHU Dupuytren, 02 avenue Martin Luther King, 87000 Limoges, France.
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Fedou
authors.affiliation: Service d'Anesthésie-Réanimation, Hôpital Mère Enfant, 08 avenue Dominique Larrey, 87000 Limoges, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Nathan-Denizot
authors.affiliation: Service de Réanimation Polyvalente, CIC 0801, CHU Dupuytren, 02 avenue Martin Luther King, 87000 Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Clavel