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Pulmonary edema associated with tocolytic therapy.
1Division of Thoracic Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Annals of Internal Medicine
|May 1, 1989
Summary
Pulmonary edema can occur with tocolytic therapy, presenting as dyspnea and tachypnea. Early recognition and treatment with diuresis and oxygen lead to rapid improvement in pregnant patients.
Area of Science:
- Obstetrics and Gynecology
- Pulmonology
- Critical Care Medicine
Background:
- Tocolytic therapy is used to inhibit uterine contractions during pregnancy.
- Pulmonary edema is a potential, though uncommon, complication of tocolytic agents.
- General internists may encounter this condition in pregnant or postpartum patients.
Purpose of the Study:
- To describe the unique clinical features of pulmonary edema associated with tocolytic therapy.
- To enhance internists' ability to diagnose and manage this condition.
Main Methods:
- Literature search of English-language articles from 1966 to 1988 using MEDLINE.
- Review of bibliographies of pertinent articles and texts.
- Analysis of 58 case reports detailing clinical variables.
Main Results:
- Patients present with dyspnea, tachycardia, and tachypnea; chest pain may be present.
- Risk factors include sympathomimetic agents, twin gestations, and postpartum timing (within 12 hours).
- Chest X-rays show bilateral infiltrates; treatment with diuresis and oxygen yields rapid improvement.
Conclusions:
- Understanding the clinical presentation aids in prompt diagnosis and management.
- This knowledge can prevent unnecessary invasive testing for dyspnea in pregnancy.
- The mechanism is likely related to increased hydrostatic pressure, not direct toxicity.
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