Información del artículo
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.
El Texto completo está disponible en PDF
BibliografÍa
[1.]
L Landsberg, JB. Young.
Fisiología y tratamiento del sistema nervioso autónomo.
Harrison.Principios de Medicina Interna, 14, pp. 488-501
[2.]
KJ Leveno, VR Klein, DS Guzick, DR Young, DV Hankins, ML. Williams.
Singlecentre randomised trial of ritodrine hydrochloride for preterm labour.
Lancet, 1 (1986), pp. 1296-1297
[3.]
WP Hausdorff, MG Caron, RJ. Leflkowitz.
Turning of the signal: Densintization of ®adrenergic receptor function.
FASEB J, 4 (1990), pp. 2881-2889
[4.]
Canadian Preterm Labor Investigators Group.
Treatment of preterm labor with the beta-adrenergic agonist ritodrine.
N Engl J Med, 327 (1992), pp. 308
[5.]
American College of Obstetricians and Gynecologist.
Preterm Labor.
Technique Bulletin, 206 (1995),
[6.]
FG Cunningham, PC McDonald, NF Gant, JK Leveno, LC III Gilstrap, GDV Hankins, et al.
Nacimiento pretérmino.
Obstetricia, 20, pp. 855-895
[7.]
WE Roberts, JC Morrison, C Hamer, WL. Wiser.
The incidence of preterm labor and specific risk factors.
Obstet Gynecol, 76 (1990), pp. 855-895
[8.]
P Hourdequin, L Beanarczyk, R Gabriel, G Harika, C Quereux, P. Wahl.
Complications maternelles des traitementstocolytiques par les beta-mimétiques. A propos de trois cas d’oedème pulmonaire.
J Gynecol Obstet Biol Reprod, 25 (1996), pp. 528-532
[9.]
FG Cunningham, PC McDonald, NF Gant, KJ Leveno, LC III Gilstrap, GDV Hankins, et al.
Embarazo múltiple.
Williams Obstetricia, 20, pp. 742-770
[10.]
JM Carrera, J Mallafré, J Ruiz, Rodó V López, M Izquierdo, M Manubens, et al.
Embarazo gemelar.
Riesgo elevado obstétrico, pp. 249-275
[11.]
P Boulot, B Hedon, G Pelliccia, P Sarda, F Montoya, P Mares, et al.
Favorable outcome in 33 triplet pregnancies managed between 1985-1990.
Eur J Obstet Gynecol Reprod Biol, 43 (1992), pp. 123-129
[12.]
Dapena MJ Cerqueira, Roura L. Cabero.
Asistencia a la gestación multifetal.
Manual de asistencia a la patología obstétrica, pp. 793-819
[13.]
Ll. Cabero.
Parto pretérmino.
Riesgo elevado obstétrico, pp. 47-95
[14.]
HR Elliott, U Abdulla, PJ. Hayes.
Pulmonary oedema associated with ritodrine infusion and betamethasona administration in premature labour.
Br Med J, 2 (1978), pp. 799-800
[15.]
M. Katz, PA Robertson, RK. Creasy.
Cardiovascular complications associated with terbutaline treatment for preterm labor.
Am J Obstet Gynecol, 139 (1981), pp. 605-608
[16.]
TJ Benedetti, R Valle, WJ. Ledger.
Antepartum pneumonia in pregnancy.
Am J Obstet Gynecol, 144 (1982), pp. 413-417
[17.]
TJ. Benedetti.
Maternal complications of parenteral ®-sympathomimetic therapy for premature labor.
Am J Obstet Gynecol, 145 (1983), pp. 1-5
[18.]
WC Mabie, ML Pernoll, JB Witty, MK. Biswas.
Pulmonary edema induced by betamimetic drugs.
South Med J, 76 (1983), pp. 1354-1360
[19.]
RJ Pisano, EC. Rosenow.
Pulmonary edema associated with tocolytic therapy.
Ann Intern Med, 110 (1989), pp. 714-718
[20.]
SE Weinberger, ST. Weiss.
Enfermedades pulmonares.
Complicaciones médicas durante el embarazo, pp. 436-481
[21.]
I Ingemersson, B. Bendtsson.
A five years experience with terbutaline for preterm labor: low rate of severe side effects.
Obstet Gynecol, 66 (1985), pp. 176-180
[22.]
RW Schrier, R Liberman, RC. Ufferman.
Mechanism of antidiuretic affect of beta adrenergic stimulation.
J Clin Invest, 51 (1972), pp. 97-111
[23.]
G Grospietsch, M Fenske, TJ Girndt, E Ulrich, W. Kuhn.
The renin-angiotensinaldosterone system, antidiuretic hormonal levels and water balance under tocolytic therapy with fenoterol and verapamil.
Int J Gynecol Obstet, 17 (1980), pp. 590-595
[24.]
A Lammintausta, R. Erxtola.
Effect of long-term salbutamol treatment on renin-aldosterone system in twin pregnancy.
Acta Obstet Gynecol Scand, 58 (1979), pp. 447-452
[25.]
O Rusn, C Lupan, V. Baltescu.
Magneziul serie in sarcina normala la termen si nasterea prematura. Rolul magneziterapiei in combatera nasterii permature.
Obstet Ginecol, 14 (1966), pp. 215-224
[26.]
T Philipsen, PS Ericsen, F. Lynggard.
Pulmonary edema following ritodrine-saline infusion in premature labor.
Obstet Gynecol, 58 (1981), pp. 304-308
[27.]
Y Domenichini, JM. Thoulon.
Accidentes cardiovasculaires des bêtamimétiques en obstétrique.
J Gynecol Obstet Biol Reprod, 11 (1982), pp. 861-867
[28.]
PG. Stubblefield.
Pulmonary edema occuring after therapy whith dexamethasona and terbutaline for premature labor.
Am J Obstet Gynecol, 132 (1978), pp. 341-342
[29.]
Rodríguez HJ. Alfaro.
Edema pulmonar agudo en el embarazo.
Complicaciones médicas en el embarazo, (1996), pp. 305-312
[30.]
TM Peck, F. Arias.
Hematologic changes associated with pregnancy.
Clin Obstet Gynecol, 22 (1979), pp. 785-798
[31.]
JA. Pritchard.
Changes in the blood volume during pregnancy and delivery.
Anesthesiology, 26 (1965), pp. 393-399
[32.]
PG Whittaker, S MacPhail, T. Lind.
Serial hematologic changes and pregnancy outcome.
Obstet Gynecol, 88 (1996), pp. 33-39
[33.]
FG Cunningham, PC MacDonald, NF Gant, JK. Leveno, LC III Gilstrap, GDV Hankins, et al.
Adaptaciones maternas al embarazo.
Williams Obstetricia, 20, pp. 175-207
[34.]
M. De Swiet.
The respiratory system.a.
Clinical Physiologic in Obstetrics, 2, pp. 83-107
[35.]
JA Pritchard, RM. Adams.
Erythrocyte production and destruction during pregnancy.
Am J Obstet Gynecol, 79 (1960), pp. 750-755
[36.]
JA Widness, GK Clemons, JF García, R. Schwartz.
Plasma immunoreactive erythropoietin in normal women studied sequentially during and after pregnancy.
Am J Obstet Gynecol, 149 (1984), pp. 646-650
[37.]
SL Clark, DB Cotton, C Bishop, Y Hill, J. Southwick.
Central hemodynamic assessment of normal term pregnancy.
Am J Obstet Gynecol, 161 (1989), pp. 1439-1442
[38.]
PI Wu, V. Udani.
Colloid osmotic presure: variations in normal pregnancy.
J Perinatol, 11 (1983), pp. 193-199
[39.]
B, Goni, DB Cotton, T. Spillman.
Peripartum colloid osmotic changes: effects of controlled fluid management.
Am J Obstet Gynecol, 151 (1985), pp. 812-817
[40.]
HN Nguyen, SL Clark, J Greenspoon, P Diesfield, PY. Wu.
Peripartum colloid osmotic pressures: correlation with serum proteins.
Obstet Gynecol, 68 (1986), pp. 807-810
[41.]
EG tRobertson, GA. Cheyne.
Plasma biochemistry in relation to oedema of pregnancy.
J Obstet Gynecol Br Comm, 79 (1972), pp. 769-774
[42.]
RK Bhatia, SF Bottoms, AA Saleh, GS Norman, EF Mammen, RJ. Sokol.
Mechanisms for reduced colloid osmotic pressure in preeclampsia..
Am J Obstet Gynecol, 157 (1987), pp. 106-108
[43.]
NF Gant, GL Daley, S Chand, PJ Whalley, PC. MacDonald.
A study of antiotensin II pressor response throughout primigravid pregnancy.
J Clin Invest, 52 (1973), pp. 2682-2689
[44.]
NF Gant, GL Daley, S Chand, PJ Whalley, PC. MacDonald.
The nature of pressor responsiveness to angiotensin II in human pregnancy..
Obstet Gynecol, 43 (1974), pp. 845-861
[45.]
FG Cunningham, K Cos, NF. Gant.
Further observation on the nature of pressor responsivity to angiotensin II in human pregnancy.
Obstet Gynecol, 46 (1975), pp. 581-583
[46.]
LC. Chelsey.
Renin, angiotensin, and aldosterone in pregnancy.
Hipertensive dissorders in pregnancy, pp. 236-270
[47.]
P August, FB Mueller, JE Sealey, TG. Edersheim.
Role of renin-ngiotensin system in blood pressure regulation in pregnancy.
Lancet, 345 (1995), pp. 896-897
[48.]
RB Everett, RJ Worley, PC MacDonald, NF. Gant.
Effects of the prostaglandin synthetase inhibitors on presor response to angiotensine II in human pregnancy.
J Clin Endocrinol Metab, 46 (1978), pp. 1007-1010
[49.]
F Broughton-Pipkin, RS. Melrelles.
Prostaglandin E2 attenuates the presor response to angiotensine II in pregnant subjects but not in nonpregnant subjects..
Am J Obstet Gynecol, 142 (1982), pp. 168-173
[50.]
A Huisman, JG Aarnouce, JHA Heuvelsmans, H Goshiga, V Fidler, HJ Huijes, et al.
Whole blood viscosity during normal pregnancy.
Br J Obstet Gynecol, 94 (1987), pp. 1143-1149
[51.]
WC Mabie, TG DiSessa, LG Crocker, MB Sibai, KL. Arheart.
A longitudinal study of cardiac output in normal human pregnancy.
Am J Obstet Gynecol, 170 (1994), pp. 849-856
[52.]
TJ Benedetti, B Kates, V. Williams.
Hemodynamic observations of severe preeclampsia complicated by pulmonary edema..
Am J Obstet Gynecol, 15 (1985), pp. 330-334
[53.]
TD Rafferty, RL. Berkowitz.
Hemodynamics in patients with severe toxemia during labor and delivery.
Am J Obstet Gynecol, 138 (1980), pp. 263-270
[54.]
G Kleinman, B Nuwayhid, R. Rudelstorfer.
Circulatory and renal effects of ®-adrenergic stimulation in pregnancy sheep.
Am J Obstet Gynecol, 149 (1984), pp. 865-874
[55.]
CA Nimrod, P Beresford, M Frais, I Belenkie, J Tyberg, A Fremit, et al.
Hemodynamic observations on pulmonary edema associated with a ®-mimetic agent. A report of two cases.
J Reprod Med, 29 (1984), pp. 341-344
[56.]
J Bieniarz, A Ivankovich, A. Scommegna.
Cardiac outpout during ritodrine treatment in premature labor.
Am J Obstet Gynecol, 118 (1974), pp. 910-920
[57.]
JM Wagner, MJ Morton, KA. Johnson.
Terbutaline and maternal cardiac function.
JAMA, 246 (1981), pp. 2697-2701
[58.]
DB Cotton, HT Strassner, LG Lipson, DA. Golstein.
The effects of terbutaline on acid-base serum electrolytes and glucose homeostasis during management of preterm labor.
Am J Obstet Gynecol, 141 (1981), pp. 617-624
[59.]
NT. James.
On the cause of sudden death in pheocromocytoma, with special reference to the pulmonary arteries, the cardiac conduction system and the agregation of platelets..
Circulation, 54 (1976), pp. 348-356
[60.]
TJ Benedetti, KA. Hargrove.
Maternal pulmonary edema during premature labor inhibition.
Obstet Gynecol, 59 (1982), pp. 335-375
[61.]
CG Hatjis, M. Swain.
Systemic tocolysis for premature labor is associated with an increased incidence of pulmonary edema in the presence of maternal infection.
Am J Obstet Gynecol, 159 (1988), pp. 723-728
[62.]
WG Dodds, JD. Iams.
Maternal C-reactive protein and preterm labor.
J Reprod Med, 32 (1987), pp. 257-530
[63.]
L Cabero, FJ. Latorre.
Complicaciones pulmonares (edema pulmonar) de los betasimpaticomiméticos.
Curas intensivas en Perinatología, pp. 77-83
[64.]
JF Larsen, K Eldon, AP Lange, M Leeguard, M Osler, JS Olsen, et al.
Ritodrine in the treatment of preterm labor: second Danish multicenter study.
Obstet Gynecol, 67 (1986), pp. 607-613
[65.]
KJ Leveno, BB Littel, FG. Cunningham.
The national impact of ritodrine hydrochloride for inhibition of preterm labor.
Obstet Gynecol, 76 (1990), pp. 12-15
[66.]
The Canadian Preterm Labor Investigation Group.
Treatment of preterm labor with ®-adrenergic agonist ritodrine.
N Engl J Med, 327 (1992), pp. 308-312
[67.]
M Higby, EMJ Xenakis, CJ. Paverstein.
Do tocolytic agents stop preterm labor? A critical and comprehensive review of efficacity and safety.
Am J Obstet Gynecol, 168 (1993), pp. 1247-1259
[68.]
R Gabriel, G Harikai, D Saniez, S Durot, C Quereux, P. Whal.
Prolonged intravenous ritodrine therapy: a comparison between multiple and singleton pregnancies.
Eur J Obstet Gynecol Reprod Biol, 57 (1994), pp. 65-71
[69.]
RF Casper, SJ. Lye.
Myometrial desensitization to continuous but not to intermittent ®-adrenergic agonist infusion in the sheep.
Am J Obstet Gynecol, 154 (1986), pp. 301-305
[70.]
SJ Lye, BA Dayes, CL Freitag, J Brooks, RF. Casper.
Failure or ritodrine to prevent preterm labor in sheep.
Am J Obstet Gynecol, 167 (1992), pp. 1399-1408
[71.]
G. Noblot.
The use of micronized progesterone in the treatment of menace of preterm delibery.
Eur J Obstet Gynecol Reprod Biol, 40 (1991), pp. 203-209
[72.]
CH. Hendricks.
The case for nonintervention in preterm labor.
Preterm labor, pp. 93-107
[73.]
J Esteban-Altirriba, Sánchez P Durán, B Roca, A Martí, JJ. Ubieto.
Prematuridad.
Clin Invest Gin Obst, 18 (1991), pp. 339-352
[74.]
GDV. Hankins.
Complications of beta-sympathomimetic tocolytic agents.
Critical care in obstetrics, pp. 223-250
[75.]
RB Newman, C Hamer, MC. Miller.
Outpatient triplet management: a contemporary review.
Am J Obstet Gynecol, 161 (1989), pp. 547-555
[76.]
AM Peaceman, SL Dooley, SK Tamura, ML. Socol.
Antepartum management of triplet gestations.
Am J Obstet Gynecol, 67 (1992), pp. 243-248
[77.]
DB Cotton, MM Jones, S Longmire, KF Dorman, J Tessem, TH III. Joyce.
Role of intravenous nitroglycerin in the treatment of severe pregnancy-induced hypertension complicated by pulmonary edema.
Am J Obstet Gynecol, 154 (1986), pp. 91-93
[78.]
LC Tejerizo, A Teijelo, F Corredera, J Moro, Sánchez MM Sánchez, Escanilla JA Pérez, et al.
Cardiopatía y gestación.
Clin Invest Gin Obst, 25 (1998), pp. 387-405
[79.]
FG Cunningham, JA Pritchard, GDV Hankins, PL Anderson, MJ Lucas, KF. Armstrong.
Peripartum heart failure idiopathic cardiomyopathy or compounding cardiovascular events?.
Obstet Gynecol, 67 (1986), pp. 157-168
[80.]
MB tLampert, J Hibbard, L Weiner, J Briller, M Lindheimer, RM. Lang.
Peripartum heart failure associated with prolonged tocolytic therapy.
Am J Obstet Gynecol, 168 (1993), pp. 493-495
Copyright © 2001. Elsevier España, S.L.. Todos los derechos reservados
