Introduction
Acute pulmonary oedema in pregnancy is associated with increased maternal and foetal morbidity. Cardiac disease and preeclampsia are recognised causes of acute pulmonary oedema. Nifidpine induced acute pulmonary oedema in pregnancy is uncommon and under recognised in clinical practice. There are many case reports of acute pulmonary oedema associated with intravenous Nicardipine and beta 2 agonist. We report a case of acute pulmonary oedema associated with standard dose of oral Nifidipine possibly confounded by concurrent intravenous steroids and fluids.
Case report:
28 year old female, G2P1, presented with antepartum haemorrhage at 32 weeks of gestation to a regional hospital. She was previously well with no significant surgical or medical history. She was treated for preterm labour with Betamethasone 11mg and Nifedipine 20mg, 6 hourly. After 12 hours of the second dose of betamethasone she developed palpitation and shortness of breath. The heart rate was 144 beats per minute regular with an oxygen saturation of 93% in room air with rest of the observations within normal range. Examination was unremarkable apart from bibasal fine crackles in the lungs. Chest Xray showed evidence of pulmonary oedema, CT pulmonary angiogram was negative for acute thromboembolic disease and echocardiogram was normal. Septic and pre eclampsia screen were negative. The Brain natriuretic peptide and troponin were elevated to 880 and 0.046 respectively.
A diagnosis of acute pulmonary was made on the basis of clinical and radiological findings. She was treated with intravenous frusemide 40mg daily for 24 hours. After 24 hours her heart rate reduced to 90 beats per minute and oxygen saturation improved to normal. Nifedipine and intravenous fluids were stopped at the same time. A diagnosis of Nifedipine induced acute pulmonary oedema was established after excluding other causes for shortness of breath.