Prediction of patients with higher order multifetal pregnancy at risk for postpartum pulmonary edema.

OBJECTIVE

This retrospective study aims to verify the factors for the development of maternal pulmonary edema in higher order multifetal pregnancy.

STUDY DESIGN

We analyzed medical profiles of a total of 13 triplet, quadruplet and quintuplet pregnancies for the years 1992 through 1997. Some treatments were applied in attempts to promote these multifetal pregnancies. All underwent cesarean section, two of which developed pulmonary edema within a few hours of delivery. There had been no evidence for the development of pulmonary edema antepartum.

RESULTS

In the patients affected by pulmonary edema, postoperative values of PaO2/FIO2<250 mmHg showed close association to a value perioperative fluid loading index (FLI)>0; the index consists of an intraoperative fluid balance and preoperative infusion volume within 24 h prior to surgery. Two patients with postoperative pulmonary edema had a perioperative FLI>0, whereas the others had values <O. There was no difference between the groups with and without pulmonary edema in other factors known to induce pulmonary edema including intraoperative infusion volume and fluid balance, weight gain and hypertension during pregnancy, preoperative SpO2, and infusion period and rate of ritodrine.

CONCLUSION

These findings demonstrate that patients in whom the perioperative FLI is >0 may have a much higher risk for postoperative pulmonary edema, suggesting the predictive role of the perioperative FLI value.