Acute Respiratory Failure in Two Pregnant Women during Tocolytic Treatment: Two Case Reports

Abstract

Acute respiratory failure due to pulmonary complications or acute respiratory distress syndrome (ARDS) is a life-threatening condition during pregnancy. The incidence of pulmonary edema is 24% in all critical illnesses associated with pregnancy. The causes are numerous, having both cardiogenic and non-cardiogenic origins, and include sepsis, tocolytic agents, and preeclampsia. The mortality rate could be as high as 23% in patients with ARDS. We report 2 patients with acute pulmonary complications during the 2nd trimester of pregnancy: 1 patient was diagnosed with tocolytic-associated pulmonary edema, and the other had septicemia-related ARDS. Both of them had received prolonged tocolytic treatment presenting with dyspnea, fever, and hemodynamic instability, and required invasive ventilation; they both received fluid and vasopressor management guided by a pulmonary artery catheter and the best supportive care. The 2 patients survived and were weaned from the mechanical ventilator successfully during their stay at the intensive care unit (ICU). Their babies survived, although 1 was delivered in the ICU on the 4(superscript th) day due to precipitated labor. In this case, the mother and her baby required long-term rehabilitation after discharge.