Acute pulmonary edema in labor can be fatal

The article was professionally consulted by Specialist Doctor II Bui Thi Thu - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.

Pregnant women with certain cardiovascular diseases, gestational hypertension, pre-eclampsia or eclampsia, or infections during pregnancy are at risk of acute pulmonary edema during labor.

During pregnancy due to changes related to the fetus, many women may experience problems related to cardiovascular disease, gestational hypertension, pre-eclampsia, eclampsia or maternal Infections during pregnancy are very likely to cause acute pulmonary edema in obstetrics. Acute pulmonary edema is also caused by too much fluid infusion and at a rapid rate. Acute pulmonary edema can occur during pregnancy, during labor or even after delivery.
Acute pulmonary edema in obstetrics is likely to lead to death for both mother and child if not detected early, diagnosed and treated promptly. In fact, in some localities, especially at the frontline, there are cases of acute pulmonary edema occurring in pregnant women during labor but late detection and poor management, leading to unfortunate consequences.

Heart disease: Depending on the severity of acute pulmonary edema, severe or mild, of which the most typical is mitral stenosis with its main complication is pulmonary edema (70-90%). The narrower the narrower the more severe the disease, the greater the risk of complications. In case of damage to many heart valves, the acute pulmonary edema in obstetrics is more severe. Number of births: Those who have given birth have a lower risk of developing heart disease and acute pulmonary edema during labor than those with multiple births. Gestational age: The older the fetus is, the more likely the occurrence of acute pulmonary edema in obstetrics is. Gestational hypertension, especially severe preeclampsia, is a favorable condition for acute pulmonary edema to occur in the case of intravascular filling procedures performed under epidural or spinal anesthesia in insensitivity to hypertensive women. Acute obstetric pulmonary edema can also occur in the postpartum period, this is the peak period, can be more severe than during pregnancy, usually blood pressure rises to a high value by 12 hours. postpartum. This is the period when heart failure and acute pulmonary edema are likely to appear, the risk will increase if there is a lot of edema and a lot of fluid is given during delivery. Medical conditions such as anemia, malnutrition, infections, malaria and kidney disease, drug poisoning and other toxic substances... are possible risks leading to acute pulmonary edema during labor.

Acute pulmonary edema in obstetrics can appear during pregnancy, labor or postpartum
Sudden shortness of breath, rapid breathing, cough, purple lips and extremities, panic, tightness in chest, limbs cold, cold sweat. Auscultation of the lungs revealed small moist rales at the bottom of the lung rising rapidly, percussion was cloudy at the bottom of the lung. From a dry cough, he spits out more and more pink foamy sputum. Auscultation: tachycardia > 100 beats/min, accompanied by pathological heart sounds. Sometimes I hear the sound of a horse galloping. Blood pressure measurement: high or stuck blood pressure. Measure central venous pressure (CVP) high, with signs of distended neck veins. Cardiopulmonary X-ray showed faint pulmonary signs. Note that it is important to differentiate an asthma attack with auscultation of the lungs with many crackles and snoring, resounding percussion, chest tightness, and heart attack with the presence of dyspnea on expiration, rales.

Before a case of acute pulmonary edema in obstetrics, the initial aggressive management plays an important role in helping the mother through the critical crisis. Check and monitor vital signs: pulse, blood pressure, breathing rate, temperature, auscultation. Make sure the mother's airway is clear by lying with her head elevated. Suctioning sputum sputum clears the respiratory tract, allowing the mother to breathe oxygen. Re-establish an intravenous line. Advise the family about the severity of acute pulmonary edema in obstetrics, the possible risks for the mother and the baby. The commune level must inject 10mg of morphine under the skin and transfer to the district level immediately, accompanied by medical staff, giving the mother oxygen (if available), keeping her head elevated when transferring.

For grassroots level
Notify upline for help, mobilize all available staff to focus on emergency maternity care. Perform initial treatment. Family counseling and referral, accompanied by medical staff. District level and above
For pregnant women to sit upright, legs hanging. Garo three limbs rotate. Intubation to suck sputum, breathe oxygen 60% with a capacity of 8-12 liters / min. Intravenous: 128 Diuretics (the drug of choice is usually lasix 20mg x 4 ampoules). When necessary, the dose can be increased, depending on the amount of urine and the patient's shortness of breath. Cardiac support: 0.4mg of cedilanit x 1-2 ampoules. 10mg morphine subcutaneously. In many cases, venous blood extraction is required. It is recommended to extract 300ml of blood. Obstetric management: Caesarean section surgery when the pregnant woman's condition allows or forceps if eligible. support, oxygen. Use intravenous dopamine. Plasma transfusion. Use high doses of antibiotics. Methyl prednisolone: ​​30mg intravenously, every 4 hours. Caesarean section when maternal condition allows or perform forceps if eligible. At Vinmec International General Hospital, there is a package maternity service as a solution to help pregnant women feel secure because of the companionship of the medical team throughout the pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of qualified doctors Regular check-up, early detection of abnormalities Maternity package helps to facilitate the process. birthing process Newborns get comprehensive care