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Case Reports
. 2020 Jan 11:25:e00173.
doi: 10.1016/j.crwh.2020.e00173. eCollection 2020 Jan.

Maternal pulmonary edema after 46 h of ritodrine hydrochloride administration: A case report

Tsuyoshi Murata  1 , Hyo Kyozuka  1 , Aya Shiraiwa  1 , Hirotaka Isogami  1 , Toma Fukuda  1 , Aya Kanno  1 , Akiko Yamaguchi  1 , Keiya Fujimori  1
Affiliations
Case Reports

Maternal pulmonary edema after 46 h of ritodrine hydrochloride administration: A case report

Tsuyoshi Murata et al. Case Rep Womens Health. .

Abstract

Introduction: Ritodrine hydrochloride is still widely used as a tocolytic agent in Japan, but it can cause maternal pulmonary edema, which may paradoxically induce preterm birth. Here we present a case of severe pulmonary edema due to <48 h of ritodrine administration.

Case: A 46-year-old woman was diagnosed with threatened preterm labor (TPL) and placenta previa at 26 weeks of gestation. She had mild uterine contractions and genital bleeding. Ritodrine hydrochloride, magnesium sulfate, and betamethasone were administered. She developed dyspnea 46 h after starting ritodrine administration. Chest X-ray showed pulmonary edema. Even after cessation of ritodrine, dyspnea did not lessen and there were regular uterine contractions with abdominal pain. Emergency caesarean section was performed. A female neonate was delivered and admitted to the neonatal intensive care unit. After surgery, maternal dyspnea decreased without any complications.

Discussion: Excessive use of ritodrine or its use in combination with other tocolytic agents can cause maternal pulmonary edema, even with <48 h of use. Adverse maternal side-effects and rebound uterine contractions due to cessation of ritodrine may paradoxically trigger preterm birth. Strict patient selection for tocolytic therapy is essential and ritodrine requires caution because of its potential side-effects.

Keywords: Betamethasone; Magnesium sulfate; Pulmonary edema; Ritodrine hydrochloride.

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Figures

Fig. 1
Fig. 1
Chest X-ray showed a butterfly pattern of acute pulmonary edema and the cardio thoracic ratio was 53%.
Fig. 2
Fig. 2
Pulmonary edema resolved on chest X-ray 4 days after surgery.
See this image and copyright information in PMC

References

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