Acute pulmonary edema due to severe preeclampsia in advanced maternal age women.

Abstract

OBJECTIVE\nAcute pulmonary edema is a rare complication in women with preeclampsia especially at advanced maternal age. We aimed to determine the cardiovascular hemodynamics in advanced maternal age women who developed acute pulmonary edema and preeclampsia.\n\n\nSTUDY DESIGN\nRetrospective cohort study of women aged over 45\xa0years giving birth at single university affiliated tertiary medical center which developed acute pulmonary edema due to severe preeclampsia. Clinical features were identified in order to predict and potentially prevent this severe complication of pregnancy.\n\n\nMAIN OUTCOME MEASURES\nAdvanced maternal age women who developed acute pulmonary edema due to preeclampsia.\n\n\nRESULTS\nOverall, during the study period 90,540 women delivered in our hospital, of them, 540 women (0.6%) above the age of 45\xa0years gave birth. Of those, 67 women (12.4%) had preeclampsia in which 4 women (6%) were complicated with acute pulmonary edema. The common clinical relevant characteristics for all four women were: preterm delivery by cesarean section for preeclampsia with severe features, non-restrictive fluid management around the time of delivery, post-partum pain control medication with non-steroidal anti-inflammatory drug, blood pressure stabilization with oral labetalol and a sudden hemodynamic deterioration to hypertensive crisis and pulmonary edema between post-operative days 4-9.\n\n\nCONCLUSION\nAlthough the precise trigger for the sudden presentation of acute pulmonary edema remains unknown, we suggest that there is a multi-factorial combination of etiologies that are common to women of advanced maternal age and women with preeclampsia that could have contributed to the development of pulmonary edema.