Keywords
Pulmonary edema
Cesarean section
Anesthesia
Submitted : 2024-12-17
Accepted : 2025-01-01
Published : 2025-01-16
Abstract
Acute pulmonary edema is a leading cause of death in patients with preeclampsia. The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema, who required an emergency cesarean section, posing a significant challenge to the anesthesiologist. The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen. Due to contraindications for neuraxial anesthesia, the cesarean section was performed under general anesthesia. After induction of anesthesia, the patient’s hypoxemia worsened. Eventually, after treatment with fluid restriction, diuretics, and albumin, oxygenation improved gradually, and the procedure was performed successfully. Both the patient and the newborn had a good prognosis.
References
Torres-Torres J, Espino-Y-Sosa S, Martinez-Portilla R, et al., 2024, A Narrative Review on the Pathophysiology of Preeclampsia. Int J Mol Sci, 25(14): 7569. https://doi.org/10.3390/ijms25147569
Reddy Eleti M, Agrawal M, Dewani D, et al., 2023, Serum LDH Levels in Normotensive and Preeclamptic-Eclamptic Pregnant Women and Its Correlation With Fetomaternal Outcome. Cureus, 15(4): e37220. https://doi.org/10.7759/cureus.37220
Joubert LH, Doubell AF, Langenegger EJ, et al., 2022, Cardiac Magnetic Resonance Imaging in Preeclampsia Complicated by Pulmonary Edema Shows Myocardial Edema with Normal Left Ventricular Systolic Function. Am J Obstet Gynecol, 227(2): 292.e1–292.e11. https://doi.org/10.1016/j.ajog.2022.03.009
Ram M, Anteby M, Weiniger CF, et al., 2021, Acute Pulmonary Edema Due to Severe Preeclampsia in Advanced Maternal Age Women. Pregnancy Hypertens, 25: 150–155. https://doi.org/10.1016/j.preghy.2021.05.019
Keepanasseril A, Monárrez-Espino J, Vadivelu P, et al., 2020, Risk Factors of Pulmonary Edema in Women with Preeclampsia from South India: A Case-Control Study. J Hum Hypertens, 34(10): 727–734. https://doi.org/10.1038/s41371-020-0300-1
Ambrožič J, Lučovnik M, Cvijić M, 2024, The Role of Lung and Cardiac Ultrasound for Cardiovascular Hemodynamic Assessment of Women with Preeclampsia. Am J Obstet Gynecol MFM, 6(3): 101306. https://doi.org/10.1016/j.ajogmf.2024.101306
Bonnet MP, Garnier M, Keita H, et al., 2021, Guidelines for the Management of Women with Severe Pre-eclampsia. Anaesth Crit Care Pain Med, 40(5): 100901. https://doi.org/10.1016/j.accpm.2021.100901
Pandya ST, Krishna SJ, 2021, Acute Respiratory Distress Syndrome in Pregnancy. Indian J Crit Care Med, 25(Suppl 3): S241–S247. https://doi.org/10.5005/jp-journals-10071-24036
McNeil JB, Jackson KE, Wang C, et al., 2021, Linear Association Between Hypoalbuminemia and Increased Risk of Acute Respiratory Distress Syndrome in Critically Ill Adults. Crit Care Explor, 3(9): e0527. https://doi.org/10.1097/CCE.0000000000000527
Wiedermann CJ, 2020, Phases of Fluid Management and the Roles of Human Albumin Solution in Perioperative and Critically Ill Patients. Curr Med Res Opin, 36(12): 1961–1973. https://doi.org/10.1080/03007995.2020.1840970
Yu YT, Liu J, Hu B, et al., 2021, Expert Consensus on the Use of Human Serum Albumin in Critically Ill Patients. Chin Med J (Engl), 134(14): 1639–1654. https://doi.org/10.1097/CM9.0000000000001661
Kugelmas M, Loftus M, Owen EJ, et al., 2023, Expert Perspectives for the Pharmacist on Facilitating and Improving the Use of Albumin in Cirrhosis. Am J Health Syst Pharm, 80(13): 806–817. https://doi.org/10.1093/ajhp/zxad070
Fishel Bartal M, Sibai BM, 2022, Eclampsia in the 21st Century. Am J Obstet Gynecol, 226(2S): S1237–S1253. https://doi.org/10.1016/j.ajog.2020.09.037
Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222, n.d., 2020. Obstet Gynecol, 135(6): e237–e260. https://doi.org/10.1097/AOG.0000000000003891
Alves B, Cunha F, Pereira C, 2023, Epidural Anesthesia for Cesarean Section in a Pregnant Woman With Acute Pulmonary Edema: A Case Report. Cureus, 15(8): e43994. https://doi.org/10.7759/cureus.43994
Ethy Ahammedunni A, Nour NB, Das K, 2024, Cesarean Section in a Morbidly Obese Patient With Severe Preeclampsia and Pulmonary Edema: A Case Report. Cureus, 16(7): e65877. https://doi.org/10.7759/cureus.65877