Résumé
Objectif : Nous décrivons l’intérêt et la bonne tolérance de la ventilation non-invasive lors d’un oedème pulmonaire attribué aux médicaments tocolytiques durant le travail d’une grossesse gémellaire.
Éléments cliniques: Nous rapportons le cas d’une parturiente de 31 ans, à 34 semaines d’aménorrhée d’une grossesse gémellaire, présentant un oedème aigu du poumon sévère après traitement conjugué pendant plus de 48 h de nifédipine, de nicardipine et d’atosiban à visée tocolytique. Cette patiente a présenté une hypoxie pendant le travail et a bénéficié de ventilation noninvasive permettant un accouchement par voie vaginale sous analgésie péridurale de deux jumeaux avec un score d’Apgar de 8 à cinq minutes. Les investigations ont mis en évidence un oedème aigu du poumon et des épanchements pleuraux bilatéraux importants transsudatifs sur dysfonction systolique ventriculaire gauche attribuée aux inhibiteurs calciques, d’évolution favorable après traitement symptomatique.
Conclusion: Dans un contexte d’oedème pulmonaire lors de la grossesse, la ventilation non-invasive peut être un traitement efficace et ainsi éviter le recours à l’intubation trachéale et ses complications.
Abstract
Objective: To describe the efficacy and paient acceptance of noninvasive 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 τ; 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.
Article PDF
Avoid common mistakes on your manuscript.
Références
King JF, Flenady VJ, Papatsonis DN, Dekker GA, Carbonne B. Calcium channel blockers for inhibiting preterm labour. Cochrane Database Syst Rev 2003; 1: CD002255.
Tsatsaris V, Papatsonis D, Goffinet F, Dekker G, Carbonne B. Tocolysis with nifedipine or betaadrenergic agonists: a meta-analysis. Obstet Gynecol 2001; 97: 840–7.
Abbas OM, Nassar AH, Kanj NA, Usta IM. Acute pulmonary edema during tocolytic therapy with nifedipine. Am J Obstet Gynecol 2006; 195: e3–4.
Bal L, Thierry S, Brocas E, Adam M, Van de Louw A, Tenaillon A. Pulmonary edema induced by calciumchannel blockade for tocolysis. Anesth Analg 2004; 99: 910–1.
Chapuis C, Menthonnex E, Debaty G, Koch FX, Rancurel E, Menthonnex P, Pons JC. Acute pulmonary edema during nicardipine and salbutamol therapy for preterm labor in twin pregnancy (French). J Gynecol Obstet Biol Reprod (Paris) 2005; 34: 493–6.
Janower S, Carbonne B, Lejeune V, Apfelbaum D, Boccara F, Cohen A. Acute pulmonary edema during preterm labor: role of nicardipine tocolysis (three cases) (French). J Gynecol Obstet Biol Reprod (Paris) 2005; 34: 807–12.
Vaast P, Dubreucq-Fossaert S, Houfflin-Debarge V, et al. Acute pulmonary oedema during nicardipine therapy for premature labour; Report of five cases. Eur J Obstet Gynecol Reprod Biol 2004; 113: 98–9.
Dumont M. Diaphragmatic hernia and pregnancy (French). J Gynecol Obstet Biol Reprod (Paris) 1990; 19: 395–9.
Watson NA, Morgan B. Pulmonary oedema and salbutamol in preterm labour. Case report and literature review. Br J Obstet Gynaecol 1989; 96: 1445–8.
Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006; 368: 687–93.
Katz M, Robertson PA, Creasy RK. Cardiovascular complications associated with terbutaline treatment for preterm labor. Am J Obstet Gynecol 1981; 139: 605–8.
de La Chapelle A, Benoit S, Bouregba M, Durand-Reville M, Raucoules-Aime M. The treatment of severe pulmonary edema induced by beta adrenergic agonist tocolytic therapy with continuous positive airway pressure delivered by face mask. Anesth Analg 2002; 94: 1593–4.
Conover WB, Benumof JL, Key TC. Ritodrine inhibition of hypoxic pulmonary vasoconstriction. Am J Obstet Gynecol 1983; 146: 652–6.
Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med 2001; 163: 540–77.
Lenique F, Habis M, Lofaso F, Dubois-Rande JL, Harf continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med 1997; 155: 500–5.
Villar J, Carroli G, Zavaleta N, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007; 335: 1025.
Verhaert D, Van Acker R. Acute myocardial infarction during pregnancy. Acta Cardiol 2004; 59: 331–9.
Oei SG, Oei SK, Brolmann HA. Myocardial infarction during nifedipine therapy for preterm labor. N Engl J Med 1999; 340: 154.
Lev-Sagie A, Bar-Oz B, Salpeter L, Hochner-Celnikier D, Arad I, Nir A. Plasma concentrations of N-terminal Pro-B-Type natriuretic peptide in pregnant women near labor and during early puerperium. Clin Chem 2005; 51: 1909–10.
Cenac A, Tourmen Y, Adehossi E, Couchouron N, Djibo A, Abgrall JF. The duo low plasma NT-PRO-BRAIN natriuretic peptide and C-reactive protein indicates a complete remission of peripartum cardiomyopathy. Int J Cardiol 2006; 108: 269–70.
Author information
Authors and Affiliations
Corresponding author
Additional information
Pas de source de financement.
Pas de conflit d’intérêt.
Rights and permissions
About this article
Cite this article
Perbet, S., Constantin, JM., Bolandard, F. et al. Ventilation non-invasive pour oedème pulmonaire attribué aux tocolytiques lors du travail d’une grossesse gémellaire. Can J Anesth 55, 769–773 (2008). https://doi.org/10.1007/BF03016350
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03016350