American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2020, 8(7), 185-186
DOI: 10.12691/ajmcr-8-7-6
Open AccessCase Report

Unusual Case of Acute Pulmonary Edema as a Manifestation of Postpartum Preeclampsia: A Case Report

Obed Agyei1, , James Granfortuna1 and Lawrence Klima1

1Department of Internal Medicine, Cone Health Teaching Affiliate UNC Chapel Hill Medical Center

Pub. Date: April 17, 2020

Cite this paper:
Obed Agyei, James Granfortuna and Lawrence Klima. Unusual Case of Acute Pulmonary Edema as a Manifestation of Postpartum Preeclampsia: A Case Report. American Journal of Medical Case Reports. 2020; 8(7):185-186. doi: 10.12691/ajmcr-8-7-6

Abstract

Background: Hypertensive disease of pregnancy remains a leading cause of maternal morbidity and mortality. Four subcategories of hypertensive disorders of pregnancy are recognized by the international society for the study of hypertension in pregnancy: chronic hypertension; gestational hypertension, pre-eclampsia, & white coat hypertension. Pre-eclampsia is defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 on two occasions at least 4 hours apart after 20 weeks of gestation with accompanying signs of end organ damage in a woman with previously normal blood pressure. The majority of cases present ante-partum or immediately post-partum. I review the case of a woman diagnosed with pre-eclampsia at 2 weeks post-partum. Case presentation: A 38-year-old woman presented with increasing dyspnea, orthopnea, intermittent palpitations, and central chest pain 2 weeks after an uncomplicated vaginal delivery. On arrival, she was hypertensive at 168/117, spO2 of 100% on BiPAP. Exam was notable for diffuse rales, a regular rhythm, no JVD, and 1+ peripheral edema. Urine was positive for hemoglobin and protein and the liver panel revealed transaminitis (AST=50 ALT=53), Chest X-ray demonstrated increased pulmonary vasculature congestion, confirmed on CT angiography which was negative for venous thromboembolism. Echocardiography found a preserved ejection fraction without diastolic dysfunction or valvular abnormalities. She was managed with a nitroglycerin infusion and parenteral diuresis with resolution of her pulmonary edema. Conclusion: Pre-eclampsia affects 4-9% of all pregnancies and confers a high risk for both fetal and maternal morbidity and mortality. The definitive treatment for preeclampsia is delivery of fetus and placenta but there is limited information to guide the management of post-partum pre-eclampsia. It has been hypothesized that activation of maternal platelets in the placental bed play a role in preeclampsia through activation of inflammasomes such as sFlt-1. Yes, further research is needed to explore the benefit of suppressing these inflammasomes. Although peri-partum cardiomyopathy and venous thromboembolism usually come to mind in women with cardio-pulmonary complaints post-partum. In the appropriate setting, post-partum pre-eclampsia should also be entertained in the differential.

Keywords:
Pre-eclampsia eclampsia cardiomyopathy

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Al-Safi, Zain, et al. “Delayed Postpartum Preeclampsia and Eclampsia.” Obstetrics & Gynecology, vol. 118, no. 5, 2011, pp. 1102-1107.
 
[2]  Cohen, Jonathan, et al. “Blood Pressure Changes during the First Stage of Labor and for the Prediction of Early Postpartum Preeclampsia: a Prospective Study.” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 184, 2015, pp. 103-107.
 
[3]  Veena, P., et al. “Furosemide in Postpartum Management of Severe Preeclampsia: A Randomized Controlled Trial.” Hypertension in Pregnancy, vol. 36, no. 1, Nov. 2016, pp. 84-89.
 
[4]  Kohli, S., et al. “Maternal Extracellular Vesicles and Platelets Promote Preeclampsia via Inflammasome Activation in Trophoblasts.” Blood, vol. 128, no. 17, Feb. 2016, pp. 2153-2164.
 
[5]  Robertson, Sarah A. “Preventing Preeclampsia by Silencing Soluble Flt-1?” New England Journal of Medicine, vol. 380, no. 11, 2019, pp. 1080-1082.