atosiban and Pulmonary-Edema

A 27-year-old primigravid woman with a triamniotic pregnancy presented with preterm labor at 29 weeks of gestation and acute severe pulmonary edema after treatment with atosiban.. The severe symptoms and hypoxemia of the patient led to emergency hysterotomy and intensive care unit hospitalization.. This clinical case prompted us to review the existing literature to examine studies on differential diagnoses in pregnant women with acute dyspnea. The possible pathophysiological mechanisms of this condition and the management of acute pulmonary edema are worth discussing.

Topics: Adult; Dyspnea; Female; Humans; Infant, Newborn; Obstetric Labor, Premature; Pregnancy; Pulmonary Edema; Vasotocin

Topics: Humans; Pulmonary Edema; Tocolytic Agents; Vasotocin

Topics: Humans; Pulmonary Edema; Tocolytic Agents; Vasotocin

Topics: Adult; Female; Humans; Obstetric Labor, Premature; Pregnancy; Pulmonary Edema; Tocolytic Agents; Vasotocin

Nifedipine is used as a first choice tocolytic agent in many Dutch hospitals, but its use is discouraged in multiple gestations. Atosiban, a selective oxytocin receptor antagonist that rarely causes systemic side effects, is used as an alternative.. A 32-year-old primigravida with spontaneous triplet pregnancy was admitted at 33 3/7 weeks for threatened preterm labour. For tocolysis, atosiban was administered for 48 hours together with betamethasone for foetal lung maturation. One day after treatment with atosiban she developed dyspnoea caused by pulmonary oedema. After a caesarean section and furosemide treatment the pulmonary oedema resolved. Analysis showed that atosiban was a likely cause of the pulmonary oedema.. Every patient with multiple gestation is at increased risk of pulmonary oedema. Any tocolytic agent may elicit that response, even the relatively safe atosiban.

Topics: Adult; Cesarean Section; Female; Humans; Pregnancy; Pregnancy Outcome; Pregnancy, Triplet; Pulmonary Edema; Tocolytic Agents; Vasotocin

Topics: Adult; Betamethasone; Continuous Positive Airway Pressure; Female; Humans; Pregnancy; Pulmonary Edema; Tocolytic Agents; Twins; Vasotocin

Topics: Adult; Female; Humans; Obstetric Labor, Premature; Pregnancy; Pulmonary Edema; Tocolytic Agents; Vasotocin

Topics: Adult; Female; Humans; Obstetric Labor, Premature; Pregnancy; Pulmonary Edema; Tocolytic Agents; Vasotocin

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.. 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.. When pulmonary edema occurs during pregnancy, non-invasive ventilation could be an efficacious treatment, this avoiding tracheal intubation and its complications.

Topics: Adult; Apgar Score; Delivery, Obstetric; Female; Humans; Infant, Newborn; Nicardipine; Nifedipine; Pleural Effusion; Pregnancy; Pulmonary Edema; Respiration, Artificial; Tocolytic Agents; Tomography, X-Ray Computed; Twins; Vasotocin

Preterm birth is never low risk and there are advantages gained by prolonging gestation even at relatively advanced stages of pregnancy. This means that high-value treatments should not just be reserved for high-risk pregnancies. Some women treated with tocolytics will experience adverse events, and some adverse events are particularly associated with different classes of tocolytic agents. Cardiovascular adverse events are particularly common with beta-agonists and there have been several maternal deaths from pulmonary oedema as a result of beta-agonist use for tocolysis. Calcium channel blockers are often associated with maternal hypotension, and a number of case studies reporting serious adverse events have been reported. The aim of this case study is to discuss what can be done if a patient experiences adverse events with tocolytics, and suggests approaches to continuing patient management and implications for obstetric practice.

Topics: Adolescent; Adrenergic beta-Agonists; Female; Humans; Obstetric Labor, Premature; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Pulmonary Edema; Tocolytic Agents; Vasotocin