Objective To describe the aetiology and obstetric outcome in women presenting with pulmonary oedema during pregnancy and the puerperium.
Study Design Retrospective case note analysis of 53 cases of pulmonary oedema causing significant respiratory distress and admission to intensive care at the Groote Schuur Hospital in Cape Town, South Africa.
Results Cases could be classified as cardiac (6/53; 11%), hypertensive (44/53; 83%), and septic (3/53; 6%), according to the underlying cause for pulmonary oedema. There were significant differences in the mean ejection fraction at echocardiography for cardiac versus non-cardiac groups (26% vs. 55%, p = 0.0001), as well as the presence of valvular stenosis or regurgitation (5/6 vs. 8/30, p = 0.016). Hypertensive patients were significantly more likely to deliver smaller babies when compared to cardiac patients (means of 1993g versus 2616g, p = 0.027) and mothers in the cardiac group were more likely to die (2/6 vs. 1/47, p = 0.031). The mode of delivery was Caesarean section in 85% of patients.
Conclusions Findings from this study highlight the importance of underlying cardiac disease as a predictor for maternal death in the context of a critical care setting. A proportion of patients in the cardiac group also had concurrent pre-eclampsia, and many patients in the hypertensive group also had abnormal echocardiography findings. Transthoracic echocardiography is a non-invasive investigation that can be carried out at the bedside, and is an essential diagnostic tool in obstetric patients with pulmonary oedema, as knowledge of ejection fraction can guide management, improving near-miss morbidity and mortality.
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