title: Fulminant antenatal pulmonary oedema in a woman with hypertension and superimposed preeclampsia.
abstract: An asymptomatic 40-year-old para 1 black African woman with pre-existing hypertension and a booking blood pressure of 120/80 mm Hg, was admitted with superimposed preeclampsia diagnosed because of worsening hypertension and significant proteinuria at 27+5 weeks gestation. Antenatally, her blood pressure was controlled with labetalol, and blood tests including serum creatinine were within normal limits for pregnancy. Three days later, the patient developed severe hypertension despite treatment, and reported sudden onset severe shortness of breath; oxygen saturations on air dropped to 93%. Auscultation revealed widespread crepitations leading to a working diagnosis of pulmonary oedema. Despite appropriate management, respiratory function continued to deteriorate and she required intubation, ventilation and emergency caesarean section under general anaesthesia. A live male infant was delivered floppy and was intubated and resuscitated. He awaits discharge home on oxygen. The mother's pulmonary oedema resolved postpartum. Echocardiogram showed left ventricular hypertrophy but normal left ventricular function and the patient's hypertension is being controlled on medication.
authors.affiliation: Women's Health Academic Centre, King's College London, London, UK.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kubota-Sjogren
authors.affiliation: Women's Directorate Office, 10th floor North Wing, St Thomas' Hospital Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Nelson-Piercy
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D007741:Labetalol / Q000627:therapeutic use; D011225:Pre-Eclampsia; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy; D011654:Pulmonary Edema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D007741:Labetalol