Hamada Kohei, Chigusa Yoshitsugu, Kondoh Eiji, Ueda Yusuke, Kawahara Shunsuke, Mogami Haruta, Horie Akihito, Baba Tsukasa, Mandai Masaki
Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Case Rep Obstet Gynecol. 2018 Aug 15;2018:7274597. doi: 10.1155/2018/7274597. eCollection 2018.
Pulmonary edema caused by severe preeclampsia can be an indication for pregnancy termination. We aimed to investigate whether noninvasive positive-pressure ventilation (NPPV) was useful for preeclampsia-induced pulmonary edema. Three cases of preeclampsia-induced pulmonary edema managed with NPPV in our institute were reviewed retrospectively. A literature review was conducted regarding NPPV usage during pregnancy. NPPV was initiated at 30, 20, and 24 weeks of gestation in the 3 cases. In all cases, NPPV slowed the progression of pulmonary edema and succeeded in delaying pregnancy termination by 17 days on average. Maternal outcomes were positive, and no intubation was required. Between 1994 and 2017, there were 11 articles describing 12 cases in which NPPV was applied for pulmonary edema during pregnancy. However, there has been no case of NPPV management of preeclampsia-induced pulmonary edema thus far. Maternal and fetal outcomes were positive in these 12 cases. NPPV may contribute to prolonging pregnancy in patients with poor oxygenation due to preeclampsia-induced pulmonary edema. However, patients should be closely monitored, and the decision to intubate or terminate the pregnancy should be made without delay when the maternal or fetal condition worsens.
重度子痫前期所致肺水肿可能是终止妊娠的指征。我们旨在研究无创正压通气（NPPV）对子痫前期所致肺水肿是否有用。回顾性分析了我院3例采用NPPV治疗的子痫前期所致肺水肿病例。对孕期使用NPPV的情况进行了文献综述。这3例分别在妊娠30周、20周和24周开始使用NPPV。在所有病例中，NPPV减缓了肺水肿的进展，平均成功将终止妊娠推迟了17天。产妇结局良好，无需插管。1994年至2017年期间，有11篇文章描述了12例孕期应用NPPV治疗肺水肿的病例。然而，迄今为止尚无NPPV治疗子痫前期所致肺水肿的病例。这12例产妇和胎儿结局均良好。NPPV可能有助于延长因子痫前期所致肺水肿导致氧合不良患者的孕周。然而，应密切监测患者，当产妇或胎儿情况恶化时，应毫不迟疑地决定插管或终止妊娠。
