Œdème aigu du poumon et grossesse : étude descriptive de 15 cas et revue de la littérature

Dolley, P.; Lebon, Alexis; Beucher, G.; Simonet, Thérèse; Herlicoviez, M.; Dreyfus, Michel

doi:10.1016/j.jgyn.2012.02.005

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…Of note is that in women with SMO in this setting of Cape Town in the Metro East region, South Africa, pulmonary oedema was particularly common and it occurred in almost one in five women with SMO. In this study the severe pulmonary edema in a whole region is reported 0.2%, higher than reported in other studies with pulmonary oedema in a tertiary hospital in France (0.05%) and the US (0.08%) [5,6], and lower than in an obstetric ICU in Brasil (1.5%) [7]. No other series of pulmonary oedema in women with MNM are available.…”

Section: Discussioncontrasting

confidence: 60%

“…Fluid overload is the second factor of importance. This was confirmed by the case series in the US and France reporting 21.5% and 13.3% fluid overload as underlying cause [5, 6]. Administration of too much intravenous (IV) fluid and transfusion of blood products have been described as causal factors in many studies [29, 30].…”

Section: Discussionmentioning

confidence: 85%

“…Findings on cardiac ultrasound may be helpful but are not always decisive. Still Dolley et al emphasised that echocardiography led to a change in management in 27.3% of cases [5]. Sonographic evaluation of pulmonary interstitial oedema [33] or Magnetic Resonance Imaging to identify rare complications such as myocardial oedema have been reported to be of additional value but these investigations were not performed in our study [34, 35].…”

Section: Discussionmentioning

confidence: 90%

“…Cardiac cause is the third underlying mechanism to develop pulmonary oedema and is confirmed in the various case series in South Africa (11%), Brazil (16%), USA (25.5%) and France (26.7%) [5, 6, 9, 10]. Left ventricular systolic‐ and diastolic dysfunction are main findings in pulmonary edema on cardiac ultrasound.…”

Section: Discussionmentioning

confidence: 93%

“…The scientific background to study pulmonary oedema in pregnant women is that in South Africa, the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) reported in 2015 that the majority of all maternal deaths were related to pre‐eclampsia with its associated complications of cerebral haemorrhage and pulmonary oedema [4]. Pulmonary oedema incidence in general populations of women during pregnancy or puerperium has been described for France as 0.05% during 2002–2010 [5], as 0.08% in the USA 1989–1999 [6] and as 1.5% in Brazil 2002–2005 [7]. Sibai et al described 2.9% pulmonary oedema in a population of severe preeclampsia gathered during a nine‐year period [8].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary oedema in the course of severe maternal outcome in South Africa: A cohort study combined with clinical audit

Heitkamp

Sandberg

Moodley

et al. 2023

Tropical Med Int Health

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Objectives: To describe the incidence and outcomes of pulmonary oedema in women with severe maternal outcome during childbirth and identify possible modifiable factors through audit. Methods: All women with severe maternal outcome (maternal deaths or near misses) who were referred to Tygerberg referral hospital from health facilities in Metro East district, South Africa, during 2014-2015 were included. Women with severe maternal outcome and pulmonary oedema during pregnancy or childbirth were evaluated using three types of critical incident audit: criterion-based case review by one consultant gynaecologist, monodisciplinary critical incident audit by a team of gynaecologists, multidisciplinary audit with expert review from anaesthesiologists and cardiologists. Results: Of 32,161 pregnant women who gave birth in the study period, 399 (1.2%) women had severe maternal outcome and 72/399 (18.1%) had pulmonary oedema with a case fatality rate of 5.6% (4/72). Critical incident audit demonstrated that pre-eclampsia/ HELLP-syndrome and chronic hypertension were the main conditions underlying pulmonary oedema (44/72, 61.1%). Administration of volumes of intravenous fluids in already sick women, undiagnosed underlying cardiac illness, administration of magnesium sulphate as part of pre-eclampsia management and oxytocin for augmentation of labour were identified as possible contributors to the pathophysiology of pulmonary oedema. Womenrelated factors (improved antenatal care attendance) and health care-related factors (earlier diagnosis and management) would potentially have improved maternal outcome. Conclusions: Although pulmonary oedema in pregnancy is rare, among women with severe maternal outcome a considerable proportion had pulmonary oedema (18.1%). Audit identified options for prevention of pulmonary oedema and improved outcome. These included early detection and management of preeclampsia with close monitoring of fluid intake and cardiac evaluation in case of suspected pulmonary oedema. Therefore, a multidisciplinary clinical approach is recommended.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 85%