Edema agudo de pulmón perioperatorio por asociación de nifedipino y sulfato de magnesio en gestación gemelar: Caso clínico

Abstract

Introduction: The association of various drugs is capable of creating both beneficial and counterproductive effects by synergy or addition, factors such as: dose, speed and intervals of administration must be taken into account, since they can trigger complications from mild to severe; Within these, drugs that share similar mechanisms of action deserve special care; In the same way, characteristics of each individual or stages that are taking place, such as gestational, generate physiological changes that must be taken into account since they can precipitate said complications. The case of a pregnant twin with a threat of preterm labor is presented, who is administered tocolytic treatment with nifedipine, betamethasone for lung maturation, and magnesium sulfate (MgSO4) as a neuroprotectant, which by various mechanisms such as fluid retention and cardiopulmonary disorders can trigger Cardiogenic or non-cardiogenic acute pulmonary edema, a rare complication that puts maternal-fetal well-being at risk. The use of pulmonary ultrasonography in the perioperative period made it possible to make both a rapid diagnosis and to guide an adequate treatment. Methods: A clinical case and its bibliographic review are presented. Conclusions: It is important to take measures to prevent this complication considering the independent risk factors for Acute Pulmonary Edema (PAD) during pregnancy and thus individualize pharmacotherapy, and according to some studies, do not use MgSO4 together with nifedipine.