Successful Anesthesia Management of Postoperative Maternal Pulmonary Edema and Uterine Hyperactivity following Open Fetal Myelomeningocele Repair

Case Reports in Anesthesiology ◽

10.1155/2021/6679845 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Denis Snegovskikh ◽

Konstantina Svokos ◽

Dmitri Souza ◽

Elizabeth Renaud ◽

Stephen R. Carr ◽

...

Keyword(s):

Pulmonary Edema ◽

Magnesium Sulfate ◽

Uterine Contractility ◽

Unique Case ◽

Uterine Activity ◽

Risks And Benefits ◽

The Us ◽

Myelomeningocele Repair ◽

Tocolytic Agents ◽

The Ideal

Effective tocolysis is essential after fetal myelomeningocele repair and is associated with the development of pulmonary edema. The increased uterine activity in the immediate postoperative period is commonly treated with magnesium sulfate. However, other tocolytic agents such as nitroglycerine, nifedipine, indomethacin, terbutaline, and atosiban (outside the US) have also been used to combat uterine contractility. The ideal tocolytic regimen which balances the risks and benefits of in-utero surgery has yet to be determined. In this case report, we describe a unique case of fetal myelomeningocele repair complicated by maternal pulmonary edema and increased uterine activity resistant to magnesium sulfate therapy.

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Cardiopulmonary Adverse Effects of Oral and Subcutaneous Terbutaline for Tocolysis

Journal of Pharmacy Practice ◽

10.1177/089719009600900305 ◽

1996 ◽

Vol 9 (3) ◽

pp. 181-187

Author(s):

James O'Donnell ◽

Leslie Iffy

Keyword(s):

Adverse Effects ◽

Adverse Events ◽

Pulmonary Edema ◽

Magnesium Sulfate ◽

Drug Administration ◽

Clinical Case ◽

Adverse Reactions ◽

Package Insert ◽

Cardiovascular Risks ◽

Tocolytic Agents

Are there differences between the expected or reported adverse reactions associated with terbutaline when administered orally as opposed to the parenteral routes (such as subcutaneously or intravenously)? This is a report on a pulmonary edema and subsequent death of a laboring woman who was treated with a combination of tocolytic agents in an attempt to prolong the gestation. The agents included magnesium sulfate, and subcutaneous and oral terbutaline. The intention is to alert the reader to the cardiovascular risks associated with combining tocolytic agents, and to dispel a pervasive myth that serious adverse reactions do not occur with oral tocolysis (i.e., terbutaline).1 Until recently, the package insert sheets for both manufacturers of terbutaline restricted the attribution of serious cardiovascular risks to parenteral administration only. The clinical case will be presented, followed by a review of the published literature and the reports on file in the unpublished Food and Drug Administration MedWatch database. Finally, the comparative pharmacokinetics of the oral and parenteral terbutaline is presented to help the reader understand how these adverse events are to be expected with any route of administration of the tocolytic.

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Noninvasive positive-pressure ventilation in pregnancy to treat acute pulmonary edema induced by tocolytic agents: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02704-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Kotaro Takahashi ◽

Koji Nishijima ◽

Masayuki Yamaguchi ◽

Kensuke Matsumoto ◽

Shunya Sugai ◽

...

Keyword(s):

Respiratory Failure ◽

Pulmonary Edema ◽

Magnesium Sulfate ◽

Positive Pressure Ventilation ◽

Noninvasive Positive Pressure Ventilation ◽

Breech Presentation ◽

Positive Pressure ◽

Ritodrine Hydrochloride ◽

Old Japanese ◽

Tocolytic Agents

Abstract Background We report a case of pulmonary edema induced by tocolytic agents that was successfully managed with noninvasive positive-pressure ventilation (NPPV) and resulted in extended gestation. Case presentation A 36-year-old Japanese pregnant woman received tocolytic therapy with ritodrine hydrochloride, magnesium sulfate, nifedipine, and betamethasone from 28 weeks of gestation. She developed respiratory failure. and her chest X-ray showed enlarged pulmonary vascular shadows. At 29 weeks and 1 day of gestation, she was diagnosed with pulmonary edema induced by tocolytic agents. Because respiratory failure worsened 2 days after ritodrine hydrochloride and magnesium sulfate were stopped, NPPV was initiated. Her respiratory status improved and she was weaned off of NPPV after 3 days. She underwent cesarean section because of breech presentation at 30 weeks and 0 days of gestation due to initiation of labor pains. Conclusions NPPV can be safely administered in cases of tocolytic agent-induced pulmonary edema during pregnancy.

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A unique case of unilateral pulmonary edema from partial anomalous pulmonary venous return in conjunction with superior vena cava stenosis

Clinical Imaging ◽

10.1016/j.clinimag.2021.04.015 ◽

2021 ◽

Vol 79 ◽

pp. 110-112

Author(s):

Francis Girvin ◽

Dennis Toy ◽

Joanna Escalon

Keyword(s):

Pulmonary Edema ◽

Superior Vena Cava ◽

Venous Return ◽

Superior Vena ◽

Vena Cava ◽

Unique Case ◽

Unilateral Pulmonary Edema ◽

Anomalous Pulmonary Venous Return ◽

Vena Cava Stenosis ◽

Superior Vena Cava Stenosis

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Premature birth (Clinical lecture)

HEALTH OF WOMAN ◽

10.15574/hw.2018.130.9 ◽

2018 ◽

pp. 9-12

Author(s):

I.B. Ventskovskaya ◽

◽

V.V. Bila ◽

O.S. Countryside ◽

◽

...

Keyword(s):

Magnesium Sulfate ◽

Key Words ◽

Gestational Age ◽

Evidence Based Medicine ◽

Premature Birth ◽

Preterm Labor ◽

Evidence Based ◽

Advantages And Disadvantages ◽

Based Medicine ◽

Tocolytic Agents

The article presents modern views on the pathogenesis of preterm labor, their relevance and classification. From the perspective of evidence-based medicine methods of prevention are considered. A comparison of the main tocolytic agents, their advantages and disadvantages is presented. Key words: premature birth, perinatal and infantile mortality, tocolysis, magnesium sulfate, gestational age.

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Differential Regulation of Myosin Regulatory Light Chain Phosphorylation by Protein Kinase C Isozymes in Human Uterine Myocytes

Reproductive Sciences ◽

10.1177/1933719118802062 ◽

2018 ◽

Vol 26 (7) ◽

pp. 988-996

Author(s):

Bryan F. Mitchell ◽

Mei Chi ◽

Elle Surgent ◽

Bailey M. Sorochan ◽

Curtis N. Tracey ◽

...

Keyword(s):

Protein Kinase C ◽

Protein Kinase ◽

Light Chain ◽

Myosin Light Chain ◽

Ex Vivo ◽

Neonatal Morbidity ◽

The Novel ◽

Uterine Contractility ◽

Uterine Activity ◽

Kinase C

Background: Preterm birth is the most common cause of neonatal morbidity and mortality and a common precedent to lifelong disability. Current treatment has minimal efficacy. Objective: We assessed the role of isozymes of the protein kinase C (PKC) family in regulating the phosphorylation of myosin regulatory light chains (RLCs), which regulate uterine contractility. We also explored the mechanisms through which these isozymes function. Study Design: We used a previously characterized and validated quantitative in-cell Western (ICW) assay to measure site-specific phosphorylations on myosin RLC and CPI-17. Cultures of human uterine myocytes (hUM) were treated with the potent contractile stimulant oxytocin to induce uterine contractility or a pharmacological mimic of diacyl-glycerol to stimulate the conventional and novel isozymes of the PKC family. Combinations of isozyme-selective inhibitors were used to determine the effects of the conventional and novel classes of isozymes. Results: Stimulation of PKC using phospho-dibutyrate caused immediate, concentration-dependent inhibition of uterine activity ex vivo. Using the ICW assay with hUM, the oxytocin-stimulated increase in the pro-contractile phosphorylations of myosin RLCs at serine19 and threonine18 was completely inhibited by prior treatment with phorbol-12-myristate-13-acetate, which stimulates both convention and novel classes of isozymes. Our results suggest that the conventional class of isozymes cause a reduction in phosphorylations at serine19 and threonine18 by reducing activity of myosin light chain kinase. The novel class of isozymes has 2 mechanisms of action: the first is activation of CPI-17 through phosphorylation at threonine38, which results in reduced activity of myosin light chain phosphatase and increased levels of activated myosin RLC; the second is increased phosphorylation of the N-terminal region of myosin RLC. Conclusions: Specific agonists for the conventional isozymes or inhibitors of the novel isozymes of the PKC family could be useful pharmacological agents for regulation of uterine activity.

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Red Parents, Blue Parents: The Politics of Modern Parenthood

The Forum ◽

10.1515/for-2016-0013 ◽

2016 ◽

Vol 14 (2) ◽

Cited By ~ 2

Author(s):

Laurel Elder ◽

Steven Greene

Keyword(s):

The Political ◽

American Family ◽

The Past ◽

Recent Scholarship ◽

The Us ◽

Political Impact ◽

The Ideal

AbstractOver the past several decades the major parties in the US have not only politicized parenthood, but have come to offer increasingly polarized views of the ideal American family. This study builds on recent scholarship exploring the political impact of parenthood (e.g. Elder, Laurel, and Steven Greene. 2012a.

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Efficacy and side effects of magnesium sulfate and ritodrine as tocolytic agents

American Journal of Obstetrics and Gynecology ◽

10.1016/s0002-9378(88)80035-8 ◽

1988 ◽

Vol 159 (3) ◽

pp. 685-689 ◽

Cited By ~ 48

Author(s):

Isabelle A. Wilkins ◽

Lauren Lynch ◽

Karen E. Mehalek ◽

Gertrud S. Berkowitz ◽

Richard L. Berkowitz

Keyword(s):

Side Effects ◽

Magnesium Sulfate ◽

Tocolytic Agents

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Uninformed refusals: objections to enrolment in clinical trials conducted under an Exception from Informed Consent for emergency research

Journal of Medical Ethics ◽

10.1136/medethics-2017-104736 ◽

2018 ◽

Vol 45 (1) ◽

pp. 18-21

Author(s):

Victoria Vorholt ◽

Neal W Dickert

Keyword(s):

Clinical Trials ◽

Informed Consent ◽

Human Services ◽

Emergency Research ◽

Emergency Situations ◽

Risks And Benefits ◽

Department Of Health ◽

The Us ◽

Level Of Understanding ◽

Practical Implications

Clinical trials in emergency situations present unique challenges, because they involve enrolling individuals who lack capacity to consent in the context of acute illness or injury. The US Department of Health and Human Services and Food and Drug Administration regulations allowing an Exception from Informed Consent (EFIC) in these circumstances contain requirements for community consultation, public disclosure and restrictions on study risks and benefits. In this paper, we analyse an issue raised in the regulations that has received little attention or analysis but is ethically complex. This challenge is when to solicit and honour objections to EFIC trial enrolment, including from non-legally appointed representatives. We address novel questions involving whose objections should be honoured, what level of understanding is necessary for objections to be considered valid and how hard investigators should work to offer an opportunity to object. We present a set of criteria that provide conceptual and practical guidance. We argue that objections should be honoured if they undermine one of the key assumptions that allows for the permissibility of EFIC trials: that individuals would likely not object to enrolment based on their values or preferences. We then clarify the practical implications of this approach through examination of three cases of refusal in an EFIC study.

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A Case Report: Acute Respiratory Distress in a Patient with Anemia

Journal of Family Medicine ◽

10.26420/jfammed.2021.1262 ◽

2021 ◽

Vol 8 (6) ◽

Author(s):

Kotnala S ◽

◽

Wadhawan S ◽

Parmar GM ◽

◽

...

Keyword(s):

Case Report ◽

Respiratory Distress ◽

Pulmonary Edema ◽

Cardiogenic Pulmonary Edema ◽

Unique Case ◽

Proper Management ◽

Life Threatening ◽

Timely Treatment

Acute respiratory distress can be life threatening if proper management is delayed. The cause of respiratory distress needs to be diagnosed quickly in order to administer appropriate and timely treatment. However, it is sometimes difficult to tease out various conditions that can present as acute respiratory distress. We present such a unique case of acute respiratory distress in a patient with anemia. We show how the ability to differentiate between cardiogenic and non-cardiogenic pulmonary edema can help in diagnosis and appropriate timely management of acute respiratory distress.

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