Pulmonary edema in pregnancy and the puerperium: a cohort study of 53 cases

Abstract

To describe the etiology and obstetric outcome in women presenting with pulmonary edema during pregnancy and the puerperium. As a secondary objective, we evaluated the utility of echocardiography in the investigation and management of such women. Retrospective case note analysis of 53 cases of pulmonary edema that resulted in severe respiratory distress and admission to intensive care. The study population were women accessing obstetric care at a tertiary referral center in South Africa. Cases were classified as cardiac (6/53; 11%), hypertensive (44/53; 83%), or septic (3/53; 6%), depending on the underlying cause for pulmonary edema. There were significant differences in the mean ejection fraction at echocardiography for cardiac vs. non-cardiac groups (26% vs. 55%, P=0.0001), as well as the presence of valvular stenosis or regurgitation (5/6 vs. 8/30, P=0.016). Women in the non-cardiac group were more likely to present earlier and require earlier delivery than in the cardiac group (median gestation at delivery 35 weeks vs. 38 weeks, P=0.0106) and mothers in the cardiac group were more likely to die (2/6 vs. 1/47, P=0.031). Cesarean delivery was performed in 85% of cases. Hypertensive illness is the most common underlying etiology in the development of pulmonary edema. Transthoracic echocardiography is a non-invasive investigation that can be carried out at the bedside and is a useful diagnostic tool in pulmonary edema occurring in pregnancy and the puerperium. Knowledge of ejection fraction is an important diagnostic tool to differentiate the underlying causes and to guide management.