Ventilation non-invasive pour œdème pulmonaire attribué aux tocolytiques lors du travail d'une grossesse gémellaire

Abstract

Objective: To describe the efficacy and paient acceptance of non-invasive ventilation for pulmonary edema associated with administration of tocolytic drugs during labour of a twin pregnancy. Clinical features: 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 transsudate pleural effusions with left ventricular systolic dysfunction induced by calcium-antagonist, with favourable outcome after symptomatic treatment. Conclusion: When pulmonary edema occurs during pregnancy, non-invasive ventilation could be an efficaceous treatment, this avoiding tracheal intubation and its complications. Copyright © 2008 Canadian Anesthesiologists' Society.