2001 Associates' Presentations
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Pulmonary Edema and Pregnancy
Moises Garcia, M.D.
University of Wisconsin, Sinai Samaritan Medical Center, Milwaukee, Wisconsin
Case: 30 year-old woman, coursing a 30-week pregnancy complicated with preterm labor presented with difficulty in breathing and cough within 24 hours after receiving magnesium sulfate and betamethasone. Physical findings showed blood pressure, 140/50; respirations, 28/min; temperature, 99.3°F; pulse, 115/min. Decreased lungs vesicular sounds and crackles were found. Chest roentgenography was consistent with pulmonary edema. Echocardiogram and cardiac enzymes were normal. No DVT was found on limbs doppler. A V/Q scan showed a low probablility of pulmonary embolism. She was treated with furosemide, 40 to 80 mg as needed, oxygen, and fluid restriction, with resolution of the clinical picture in 24 hours.
Discussion: The use of magnesium sulfate has become a standard indication for preeclampsia and preterm labor. Some reports have pointed the risk of pulmonary edema after using tocolytics especially when used together with steroids. However, most cases have been implicated to beta-agonists. The association of magnesium sulfate with pulmonary edema is less clear because few isolated cases have been reported. Several mechanism have been implicated in the development of pulmonary edema, however, a low colloid osmotic pressure seems to trigger the development of pulmonary edema. In our patient a decrease of toal proteins and albumin was noted.
Conclusion: Magnesium sulfate should be considered a potenital cause of pulmonary edema especially when used together with steroids and patients showing hypoalbuminemia. Close monitoring of this rare complication is advised.
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