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Cardiopulmonary effects of betamimetic tocolytic and glucocorticoid therapy in pregnant women

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Summary

In 35 present women, undergoing tocolytic treatment with betamimetics had intensive monitoring by balloon-tipped catheter. After the administration of 2–4 μg/min of fenoterol the cardiac output (CO) increased from 8.2 l/min to over 11 l/min with a corresponding increase in mean pulmonary artery pressure (MPAP) from 11.7 mmHg to over 18 mmHg. The correlation coefficient between MPAP/CO was highly significant. In the 10 patients in whom we were able to monitor pulmonary capillary pressure (PCP), we observed no significant increase to suggest compromised cardiac performance. The calculated total resistance of the pulmonary vessels (TPR) decreased during the first 24h followed by a return to initial values. Our investigations suggest that the principal cardiovascular effect of betamime-tics in pregnant women is a volume-dependent increase in pressure in the pulmonary circulation. The simultaneous administration of betamethasone had no additional effects.

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References

  1. Abramovici H, Lewin A, Lissak A, Palant A (1980) Maternal pulmonary edema occuring after therapy with ritodrine for premature uterine contractions. Acta Obstet Gynecol Scand 59: 555

    Google Scholar 

  2. Babenerd J, Flehr I (1979) Mütterliche Zwischenfälle unter Tokolyse mit Fenoterol. Med Welt 30: 537–541

    Google Scholar 

  3. Bender HG, Goeckenjan G, Meger Ch, Müntefering H (1977) Zum mütterlichen Risiko der medikamentösen Tokolyse mit Fenoterol. Geburtshilfe Frauenheilkd 37: 665–674

    Google Scholar 

  4. Benedetti TJ, Hargrove JC, Rosene KA (1982) Maternal pulmonary edema during premature labor inhibition. Obstet Gynecol [Suppl] 55: 33–37

    Google Scholar 

  5. Bergofsky EH (1980) Humoral control of the pulmonary circulation. Ann Rev Physiol 42: 221–233

    Google Scholar 

  6. Berk JL, Hagen JF, Koo R, Beyer W, Dochat GR, Rupright M, Nomota S (1983) Pulmonary insufficiency caused by Epinephrine. Ann Surg 178: 423 : 434

    Google Scholar 

  7. Caritis SN, Edelstone DJ, Mueller-Heubach E (1979) Pharmacologic inhibition of preterm labor. Am J Obstet Gynecol 133: 557–578

    Google Scholar 

  8. Carstens M, Haferkorn D (1979) Komplikation im Zusammenhang mit der Verabreichung von β-Sympathikomimetika. Arch Gynäkol 28: 143–144

    Google Scholar 

  9. Chang RSY, Wright K, Effros RM (1981) Role of albumin in prevention of edema in perfused rabbit lungs. J Appl Physiol 50: 1065–1070

    Google Scholar 

  10. Conover WB, Benumof JL, Key TC (1983) Ritodrine inhibition of hypoxic pulmonary vasocon-striction. Am J Obstet Gynecol 146: 652–656

    Google Scholar 

  11. Cotton DB, Strassner HT, Lipson LG, Goldstein DA (1981) The effects of terbutaline on acid base, serum electrolytes, and glucose homeostasis during the management of preterm labor. Am J Obstet Gynecol 141: 617–624

    Google Scholar 

  12. Curtius JM, Goeckenjan G, Steyer M, Hust M (1980) Lungenödem als Tokolyse-Komplikation. Dtsch Med Wochenschr 105: 1320–1324

    Google Scholar 

  13. Elliott HR, Abdulla M (1978) Pulmonary oedema associated with ritodrine infusion and betamethasone administration in premature labour. Br Med J 2: 799–800

    Google Scholar 

  14. Fischer JH, Wolff F, Günther W (1982) Cardiopulmonary effect of fenoterol and betamethasone in pregnant beagles — investigations using implanted catheters in conscious animals. In: Jung H, Lamberti G (eds) Beta-mimetic drugs in Obstetrics and Perinatology, Thieme, p 123–129

  15. Fischer JH, Wolff F (1983) Nebenwirkungen der Glukokortikoidgabe zur Beschleinigung der fetalen Lungenreifung unter Tokolyse. In: Ludwig H, Heilmann L (Hrsg) Wehenhemmung. Springer, Berlin Heidelberg New York Tokyo, pp 128–136

    Google Scholar 

  16. Gaar KA, Taylor AE, Owens LJ Guyton AC (1967) Effect of capillary pressure and plasma protein on development of pulmonary edema. Am J Physiol 213: 79–82

    Google Scholar 

  17. Grospietsch G, Grindt J, Fenske M, Kuhn W (1980) Zur Frage des Lungenödems bei der tokolytischen Therapie. Geburtshilfe Frauenheilkd 40: 55–64

    Google Scholar 

  18. Guyton AC, Lindsey AW (1959) Effect of elevated left artiral pressure and decreased plasma protein concentration of the development of pulmonary edema. Circ Res 7: 649–657

    Google Scholar 

  19. Jacobs MM, Knight AB, Arias F (1980) Maternal pulmonary edema resulting from betamimetic and glucocorticoid therapy. Obstet Gynecol 56: 56–59

    Google Scholar 

  20. Jung H (1974) Die Frühgeburt. Arch Gynäkol 219: 299–306

    Google Scholar 

  21. Katz M, Robertson PA, Creasy R (1981) Cardiovascular complications associated with terbutaline treatment for preterm labor. Am J Obstet Gynecol 139: 605–606

    Google Scholar 

  22. Lichtlen P, Stutz R (1956) Hämodynamische Untersuchungen mit dem p-Hydroxyphenyl-Derivat des Orciprenalins. Drug Res 19: 147–149

    Google Scholar 

  23. Meinen K, Breinl H, Schmidt EW, Wellstein A (1978) Study to confirm the lack of severe cardiac side-effects following treatment with the beta-adrenergic drug fenoterol. Gynecol Obstet Invest 9: 319–324

    Google Scholar 

  24. Metcalfe J, Ueland K (1974) Maternal cardiovascular adjustments to pregnancy. Preg Cardiovas Dis 16: 363–374

    Google Scholar 

  25. Nagey DA, Crenshaw MC (1982) Pulmonary complications of Isoxsuprine therapy in the gravida. Obstet Gynecol [Suppl] 59: 38–39

    Google Scholar 

  26. Niebuhr-Jorgensen M (1980) Pulmonary oedema following treatment with ritodrine and betamethasone in preterm labour. Dan Med Bull 27: 99–100

    Google Scholar 

  27. Nimrod C, Rambihar V, Fallen E, Effer S, Carins J (1984) Pulmonary edema associated with isoxsuprine therapy. Am J Obstet Gynecol 148: 625–629

    Google Scholar 

  28. Reichman J, Goldman JA (1981) Pulmonary edema after ritodrine infusion for premature labor in a patient with ventral disease. Acta Obstet Gynecol Scand 60: 87–88

    Google Scholar 

  29. Rogge P, Young S, Goodlin R (1979) Post partum pulmonary oedema associated with preventive therapy for premature labour. Lancet 1026–1027

  30. Slutsky R, Hooper W, Gerber K, Ashburn W, Curtis G, Karliner J (1981) Left ventricular size and function after subcutaneous administration of terbutaline. Chest 79: 501–505

    Google Scholar 

  31. Stubblefield PG (1978) Pulmonary edema occuring after therapy with dexamethasone and terbutaline for premature labor: a case report. Am J Obstet Gynecol 132: 341–342

    Google Scholar 

  32. Tinga DJ, Aarnoudse JG (1979) Post partum pulmonary oedema associated with preventive therapy for premature labour. Lancet 1026

  33. Wagner JM, Morton MJ, Johnson KA, O'Grady JP, Speroff L (1981) Terbutaline and maternal cardiac function. JAMA 246: 2697–2701

    Google Scholar 

  34. Wheeler AS, Patel KF, Spain J (1981) Pulmonary edema during beta-2 tocolytic therapy. Anaesth Analg 60: 695–696

    Google Scholar 

  35. Wolff F, Meier U, Bolte A (1979) Untersuchungen zum Pathomechanismus schwerer kardio-pulmonaler Komplikationen unter tokolytischer Behandlung mit β-adrenergen Substanzen und Betamethason. Z Geburtshilfe Perinatol 183: 343–347

    Google Scholar 

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Wolff, F., Carstens, V., Fischer, J.H. et al. Cardiopulmonary effects of betamimetic tocolytic and glucocorticoid therapy in pregnant women. Arch. Gynecol. 239, 49–58 (1986). https://doi.org/10.1007/BF02134288

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  • DOI: https://doi.org/10.1007/BF02134288

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