Acute pulmonary edema (APE) in obstetric patients is rare however, preeclampsia and heart disease predispose to the event. The objective is to describe the maternal and perinatal outcomes in patients with APE hospitalized in ICU.
A cross-sectional study including 50 patients admitted with diagnosis of APE between 2012 and 2015.
Mean age was 27.2 years, 54% were primiparous and 6% twin pregnancy. In 58% of the cases the APE occurred antepartum, 38% postpartum and 4% intrapartum. The most common etiology of APE was hypertension (66%), cardiogenic (16%), association of cardiac disease with hypertension occurred in 16% and 2% had isolated fluid overload. Regardless of etiology, in the 24 hours preceding the APE, 34% had fluid overload; although oliguria occurred in 12% of patients. Time between diagnosis and resuscitation maneuvers was five minutes and within 30 minutes in 75% of patients. Near miss criteria was present in 60% of patients and death occurred in 4%. Birth before 37 and 34 weeks occurred in 71.1% and 39% respectively. Cesarean section occurred in 78%. Neonatal resuscitation occurred in 12.7% of fetuses, 17% required noninvasive ventilation and 10.6% intubation. Mild to moderate neonatal hypoxia occurred in 16.9% of the neonates, fetal death in 9.8%, admission to neonatal ICU in 25.5% and neonatal death in 7.8%.
APE occurred more frequently antepartum and hypertension was the most common etiology. This severe disease associated with high morbidity and mortality for mother and fetus. Fluid overload seems to have importance in triggering the APE.
Instituto de Medicina Integral Prof Fernando Figueira—IMIP, Recife, Brazil
Financial Disclosure: The authors did not report any potential conflicts of interest.