Nifedipine-associated pulmonary complications in pregnancy

Abstract

Pulmonary edema (PE) is a known side effect of tocolytic agents. Recently the first case of PE associated with oral nifedipine (Adalat Bayer Germany) was reported. Two cases are added; one is a twin gestation who presented at 31-6/7 weeks in labor with ruptured membranes (ROM). Forty hours after starting betamethasone antibiotics and 40-mg nifedipine every 6 h she developed dyspnea. Arterial blood gases (ABG) revealed Pa/O2=52mmHg and saturation=88%. Bilateral crackles were detected. Chest X-ray revealed mild haziness over the left lower lobe; nifedipine was discontinued. Oxygen facemask and 3 doses of 20-mg furosemide (Lasix; Sanofi-Aventis U.S.A.) resulted in mild improvement. One episode of 38.3 °C temperature was recorded 8 h after discontinuing nifedipine so a cesarean delivery was performed. The second patient presented at 27-5/7 weeks in labor. She received betamethasone penicillin and 40-mg nifedipine every 6 h. Twenty hours later she had ROM and a temperature of 38°C. On day 3 contractions intensified; nifedipine was discontinued and MgS/O4 was given for 3 h. Three hours later she developed cough and dyspnea. Bilateral fine crackles were noted. Mg level was 5.7 mg/ dl. ABG revealed Pa/O2=45mmHg and saturation=81%. Chest X-ray revealed congestion. Duplex scan of the lower extremities was negative. She received 5 doses of 40-mg furosemide but saturation remained between 77 and 84% despite oxygen nasal-cannula and therapeutic heparin. A cesarean delivery was done. Postoperative chest X-ray suggested hilar pneumonia. Saturation improved on day 2 postoperatively. (excerpt)