Pulmonary Oedema Case Study
INTRODUCTION
Acute pulmonary oedema is a rare, but life-threatening problem which may cause significant morbidity and mortality in pregnant women. It may occur due to pathologies such as pre-eclampsia, sepsis, amniotic fluid embolism, fluid-overload or beta-adrenergic tocolytic drugs during the antenatal, intrapartum or postpartum periods. Moreover, pre-existing cardiopulmonary diseases may worsen due to the superimposed effects of physiological changes related to pregnancy (1). Management of these patients is a challenge for the anaesthesiologists, because there are no controlled studies or guidelines pointing out the best type of anaesthetic technique in these patients (2).
CASE
A 38 years old, pregnant patient with a history of rheumatic
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Cardiovascular stress related to pregnancy, labour and delivery may induce various degrees of cardiac failure in pregnants with cardiac diseases (2). A systolic pulmonary artery pressure of above 50 mmHg is associated with cardiac complications during pregnancy as functional status worsens more rapidly in pregnant patients with mitral valve stenosis. Cardiac decompensation and pulmonary oedema may occur at any time during the second or third trimester. Fluid restriction, diuretics, and control of atrial fibrillation are basic measures that can prevent pulmonary congestion (2). Safe use of NPPV and regional anaesthesia combination for caesarean section have previously described with several case reports in patients with respiratory failure due to kyphoscoliosis, neuromuscular diseases, acute respiratory distress syndrome, pneumonia and non-cardiogenic pulmonary oedema (3-5). In our patient, acute pulmonary oedema developed presumably because of tachycardia caused by anxiety and pain caused by preterm labour in our patient with pre-existing multivalvular heart disease and limited cardiac reserve. Management of these patients is difficult, because guidelines and standards are lacking. Some authors have described the use of general anaesthesia with good maternal outcome, whereas others have reported increased pulmonary arterial pressure during laryngoscopy and
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