Acute hypoxemia in a parturient with primary ciliary dyskinesia following the administration of intravenous oxytocin: a case report

Abstract

Purpose We present the case of a parturient diagnosed with primary ciliary dyskinesia with secondary bronchiectasis who developed significant hypoxemia following administration of intravenous oxytocin during Cesarean delivery under spinal anesthesia. This case suggests that oxytocin can affect pulmonary vascular tone and interfere with the protective effects of hypoxic vasoconstriction. Clinical features A 35-yr-old primigravida at 37 weeks gestation presented for a scheduled Cesarean delivery due to breech positioning and fetal abnormalities. The patient had a diagnosis of primary ciliary dyskinesia and had undergone a right middle lobectomy seven years earlier for resultant bronchiectasis. Pulmonary function testing in the month prior to delivery showed a 4% decline in her baseline FEV 1 to 1.06 L (32% of predicted value) but she was functionally well. The patient initially had an uneventful spinal anesthetic and maintained an oxygen saturation of 97% on room air in the supine position until delivery of her baby. An intravenous infusion of oxytocin for uterine contraction was started following removal of the placenta. The patient then became acutely hypoxemic with a drop in room air saturation to 84% but with no other accompanying hemodynamic instability. Maternal oxygen saturation did not improve with the addition of supplemental oxygen, and the patient had a significant arterial-alveolar oxygen gradient suggesting an intrapulmonary shunt. No supporting clinical, radiologic, or laboratory evidence of a thrombotic, air, or amniotic fluid embolism or mucous plug was detected. The patient remained hypoxemic during the postoperative period with gradual improvement back to baseline saturation in approximately 48 hr. Conclusion The vasodilatory effects of intravenous oxytocin on the pulmonary vasculature may worsen shunting and interfere with hypoxic pulmonary vasoconstriction, producing clinically significant hypoxemia in patients with comorbid lung disease. Oxytocin should be used with caution in patients with compromised lung function. RésuméObjectif Nous présentons le cas d'une parturiente ayant un diagnostic de dyskinésie ciliaire primitive avec bronchiectasie secondaire qui a développé une hypoxémie significative après l'administration intraveineuse d'ocytocine au cours d'un accouchement par césarienne sous rachianesthésie. Ce cas suggère que l'ocytocine peut affecter le tonus vasculaire pulmonaire et bloquer avec les effets protecteurs de la vasoconstriction hypoxique. Caractéristiques cliniques Une femme primigeste de 35 ans à 37 semaines de grossesse s'est présentée pour un

Integrated Transcriptome-wide Profiling and Protein Structure Analysis of Pathogenic Genes in Venous Thromboembolism

“…DPCD (rs7874) is named from an uncharacterized genomic region surrounding POLL. DPCD is a novel gene in primary ciliary dyskinesia and severe cases can induce pulmonary embolism [41]. ZNF292 (rs9362415) acts as a transcription factor and plays an important role in DNA recognition and apoptosis regulation [42].…”

ERS/TSANZ Task Force Statement on the management of reproduction and pregnancy in women with airways diseases

“…The use of prostaglandin E 2 for induction of labour or oxytocin (for augmentation of the second and third stages) has not been associated with worsening lung function or asthma exacerbation [148]. However, a recent case report outlined a woman with severe bronchiectasis (FEV 1 32% predicted) who developed acute hypoxaemia when given oxytocin for uterine contraction [149]. As the hypoxaemia was resistant to supplemental oxygen it was suggested that the oxytocin had increased shunting through the damaged lung.…”