Pulmonary edema occurring after isoxsuprine and dexamethasone treatment for preterm labor: Case report.

A case of maternal pulmonary edema occurring in a patient in the 32nd week of gestation is presented. This was our first case of pulmonary edema seen during a period of five years' usage of isoxsuprine in the treatment of premature labor. The patient presented was 28 years old, gravida 2, para 1, admitted to the maternity ward with premature uterine contractions. Her past history eliminate cardiac or pulmonary disease. Isoxsuprine therapy was begun with initial dose of 0.04 mg/min. and increased to 0.32 mg/min., the total dose administered was 560 mg during 48 hours. During this period she was given in dexamethasone 24 mg. Fluid balance on the first day of the treatment was +1.7 liters and on the second day +5.2 liters. Forty-eight hours from the commencement of the treatment, the patient experienced shortness of breath and chest pain. Physical examination disclosed wet rales over both lungs, sinus tachycardia and tachypnea. Laboratory examination disclosed hypopotassemia of 3 mEq/liter, hypoxemia (PO2 of 80 torr on 0.5 FiO2 face mask) with mild hyperventilation 28 torr PCO2 with normal ph 7.43. Recognition of the early signs of pulmonary edema enable swift clinical diagnosis and steps to be taken to prevent disasterous condition due to progressive hypoxemia. The prompt treatment in this complication includes discontinuation of isoxsuprine and fluid administration, placement of the patient in an erect position, intravenous furosemid 40 mg, oxygen supplement by face mask and 25 mg of meperidine. The patient's condition dramatically improved though the lung fields became completely clear from wet rales only eight hours from the start of dyspneic attack.(ABSTRACT TRUNCATED AT 250 WORDS)