• Sébastien Perbet, Jean-Michel Constantin, Franck Bolandard, Marie Vignaud, Denis Gallot, Sylvain Chanséaume, Marie Zénut, and Jean-Etienne Bazin.
• Département d'Anesthésie et de Réanimation, Hôtel-Dieu, Centre Hospitalier Universitaire de Clermont-Ferrand, Boulevard Léon-Malfreyt, 63058 Clermont-Ferrand Cedex 1, France. sperbet@chu-clermontferrand.fr
• Can J Anaesth. 2008 Nov 1;55(11):769-73.

ObjectiveTo describe the efficacy and patient acceptance of non-invasive ventilation for pulmonary edema associated with administration of tocolytic drugs during labour of a twin pregnancy.Clinical FeaturesWe report the case of a 31-yr-old parturient at 34 weeks gestation of a twin pregnancy, who experienced acute pulmonary edema after tocolytic treatment with nifedipine, nicardipine and atosiban of > 48 hr in duration. This patient presented with hypoxia during labour and non-invasive ventilation was successfully used allowing delivery by vaginal approach, with patient-controlled epidural analgesia, of two twins with a five minute Apgar score of 8. Investigations showed acute pulmonary edema and important transudate pleural effusions with left ventricular systolic dysfunction induced by calcium-antagonist, with favourable outcome after symptomatic treatment.ConclusionWhen pulmonary edema occurs during pregnancy, non-invasive ventilation could be an efficacious treatment, this avoiding tracheal intubation and its complications.

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