scholarly journals Nicardipin Associated Pulmonary Edema : A Severe Complication of Tocolysis - A Case Report

2018 ◽  
Vol 5 ◽  
Author(s):  
Youssef Motiaa ◽  
Wafae El Otmani ◽  
Nezha El Oudghiri ◽  
Anas Saoud Tazi
Keyword(s):  
Pulmonary Edema ◽  
Preterm Labor ◽  
Channel Blocker ◽  
Fetal Lung ◽  
Pulmonary Angiography ◽  
Acute Pulmonary Edema ◽  
Lung Maturation ◽  
Computed Tomography Pulmonary Angiography ◽  
Uterine Contractions ◽  
Fetal Lung Maturation

In preterm labor, tocolytics are used to stop uterine contractions and to allow the administration of corticosteroids for fetal lung maturation, nicardipine is a calcium channel blocker increasingly used for this indication. Several adverse effects have been reported during tocolysis using nicardipine, one of the most serious complications is Acute Pulmonary Edema. We report a case of a parturient who was admitted at 28 weeks pregnancy for preterm labor and developed a respiratory failure two days following tocolysis with nicardipine. Echocardiography and Computed Tomography Pulmonary Angiography (CTPA) ruled out a pulmonary embolism and a decompensated heart disease. The patient received oxygen therapy and diuresis for Acute Pulmonary Edema with favorable outcome.The purpose of this paper is to discuss the risk factors for occurrence of pulmonary edema after tocolysis, importance of etiologic investigation to exclude differential diagnoses and therapeutic options for management of this complication.

scholarly journals Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Claire Serena ◽  
Emmanuelle Begot ◽  
Jérôme Cros ◽  
Charles Hodler ◽  
Anne Laure Fedou ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Preterm Labor ◽  
Multiple Pregnancy ◽  
Fetal Lung ◽  
Clinical Severity ◽  
Acute Pulmonary Edema ◽  
Lung Maturation ◽  
Serious Adverse Event ◽  
Beta Agonists ◽  
Fetal Lung Maturation

We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.

scholarly journals Molecular regulation of lung maturation in near-term fetal sheep by maternal daily vitamin C treatment in late gestation

2021 ◽  
Author(s):  
Erin V. McGillick ◽  
Sandra Orgeig ◽  
Beth J. Allison ◽  
Kirsty L. Brain ◽  
Youguo Niu ◽  
...  
Keyword(s):  
Vitamin C ◽  
Lung Development ◽  
Fetal Lung ◽  
Late Gestation ◽  
Lung Maturation ◽  
Maternal Vitamin ◽  
Healthy Pregnancy ◽  
Daily Vitamin ◽  
Expression Of Genes ◽  
Fetal Lung Maturation

Abstract Background In the fetus, the appropriate balance of prooxidants and antioxidants is essential to negate the detrimental effects of oxidative stress on lung maturation. Antioxidants improve respiratory function in postnatal life and adulthood. However, the outcomes and biological mechanisms of antioxidant action in the fetal lung are unknown. Methods We investigated the effect of maternal daily vitamin C treatment (200 mg/kg, intravenously) for a month in late gestation (105–138 days gestation, term ~145 days) on molecular regulation of fetal lung maturation in sheep. Expression of genes and proteins regulating lung development was quantified in fetal lung tissue. The number of surfactant-producing cells was determined by immunohistochemistry. Results Maternal vitamin C treatment increased fetal lung gene expression of the antioxidant enzyme SOD-1, hypoxia signaling genes (HIF-2α, HIF-3α, ADM, and EGLN-3), genes regulating sodium movement (SCNN1-A, SCNN1-B, ATP1-A1, and ATP1-B1), surfactant maturation (SFTP-B and ABCA3), and airway remodeling (ELN). There was no effect of maternal vitamin C treatment on the expression of protein markers evaluated or on the number of surfactant protein-producing cells in fetal lung tissue. Conclusions Maternal vitamin C treatment in the last third of pregnancy in sheep acts at the molecular level to increase the expression of genes that are important for fetal lung maturation in a healthy pregnancy. Impact Maternal daily vitamin C treatment for a month in late gestation in sheep increases the expression of gene-regulating pathways that are essential for normal fetal lung development. Following late gestation vitamin C exposure in a healthy pregnancy, an increase in lung gene but not protein expression may act as a mechanism to aid in the preparation for exposure to the air-breathing environment after birth. In the future, the availability/development of compounds with greater antioxidant properties than vitamin C or more specific targets at the site of oxidative stress in vivo may translate clinically to improve respiratory outcomes in complicated pregnancies at birth.

Modeling Glucocorticoid-Mediated Fetal Lung Maturation: I. Temporal Patterns of Corticosteroids in Rat Pregnancy

2005 ◽  
Vol 317 (1) ◽  
pp. 117-126 ◽  
Author(s):  
Mahesh N. Samtani ◽  
Nancy A. Pyszczynski ◽  
Debra C. DuBois ◽  
Richard R. Almon ◽  
William J. Jusko
Keyword(s):  
Temporal Patterns ◽  
Fetal Lung ◽  
Lung Maturation ◽  
Fetal Lung Maturation
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