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Resumen
A portamos 2 casos de edema pulmonar por uso debetamiméticos, sobrevenidos en el curso de tratamientos tocolíticos intravenosos prolongados en casos depacientes con gestación múltiple. Si bien los betamiméticos están dotados de efectos directos sobre elmiocardio, los mecanismos fisiopatológicos involucrados son sobre todo no cardiogénicos. El principal es la retención hidrosódica consecutiva al aporte de solutospor vía intravenosa y a la acción directa de los betamiméticos sobre la excreción renal de sodio y de agua.El beneficio neonatal de las tocólisis prolongadas esaún hipotético. Si se emplea esta estrategia, la prevención de las complicaciones cardiovasculares imponeuna vigilancia materna exhaustiva, especialmente enel caso de gestación múltiple, la utilización de soluciones de betamiméticos concentrados para limitar el volumen de las perfusiones y la asociación de un tratamiento con progesterona que puede permitir reducir laposología y la duración del tratamiento tocolítico.
Summary
We report two cases of pulmonary oedema associated with prolonged intravenous tocolytic therapy with betamimetics in patients with multiple pregnancies. Although betamimetics may have direct myocardial side effects, the underlying pathological mechanism are mainly non-cardiogenic. The most important one appears to be fluid overload, related to the amount of fluids given intravenously and as a direct result of betamimetic drug on renal excretion of sodium and water. Neonatal benefit from prolonged tocolytic therapy remains hypothetical. If this strategy is used, the prevention of adverse cardiovascular effects requires exhaustive maternal supervision, especially in cases of multiple pregnancy. The use of concentrated betamimetic solutions to reduce the volume of fluids and the association of progesterone therapy can reduce the infusion rate and the duration of the tocolytic therapy.
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