HAMİLELİKTE RİTODRİN KULLANIMINA BAĞLI GELİŞEN CİDDİ SOLUNUM YETMEZLİĞİ

Öz

Ritodrin, tokolitik ajan olarak preterm doğum eyleminde kullanılmaktadır. Ritodrin tedavisi sırasında ortaya çıkan en ciddi komplikasyonlardan biri pulmoner ödemdir. Pulmoner ödem insidensi; çoğul gebelik, glukokortikoid uygulanımı, fazla sıvı verilmesi ve maternal enfeksiyon olması durumunda artmaktadır. 21 yaşında 33 haftalık ikiz gebeliği olan ve preterm doğum eylemi nedeni ile kadın doğum servisine yatırılarak ritodrin ve steroid tedavisi başlanan olgumuz, yatışının 2. gününde öksürük, dispne ve ateş gelişmesi üzerine değerlendirildi. Çekilen PA grafide bilateral diffüz konsolidasyon alanları, arteryel kan gazında ağır hipoksi ve hipokapnisi mevcuttu. Bu klinik ile pnömoni, pulmoner emboli, sepsis, akciğer ödemi ön tanılarıyla entübe edildi. Olgumuza sezeryan sonrası 2 gün mekanik ventilasyon uygulandı. Klinik olarak hızla yanıt alınan hastaya ritodrine bağlı akciğer ödemi tanısı kondu. Preterm doğum eylemi sırasında gelişen solunum yetmezlikl erinde ritodrin ve steroid uygulanması sonucu akut pulmoner ödem oluşabileceği akılda tutulmalıdır.

Anahtar Kelimeler

• Gebelik, pulmoner ödem, ritodrinks

SEVERE RESPIRATORY FAILURE DUE TO THE USE OF RITODRINE IN PREGNANCY

Abstract

Ritodrine, is used in the preterm labor as a tocolytic agent. One of the most serious complications which occur during the ritodrine treatment is pulmonary edema. Pulmonary edema incidence increases in multiple pregnancies, glucocorticoid application, and when too much liquid is given and maternal infection occurs. Our 21 years old case with a pregnancy of 33 weeks, who was accepted to the maternal service due to preterm birth event and for whom we started ritodrine and steroid treatment, was evaluated on the 2rd day after her acceptance as a result of the development of cough, dyspnea and fever signs. In her PA X-ray, there were bilateral diffuse consolidation areas, and in her arterial blood gas there were severe hypoxemia- hypocapnia. With this clinic, she was entubed with a suspicious of pneumonia, pulmonary embolism, sepsis, and pulmonary edema. Our case was applied mechanical ventilation for 2 days after the caesarian. This patient gave a rapid response clinically. We diagnosed a pulmonary edema due to ritodrine. It must be kept in mind that acute pulmonary edema may develop after the application of ritodrine and steroid in respiratory failures which occur during preterm birth event.

Keywords

• Pregnancy, pulmonary edema, ritodrine

Kaynakça

1. 1. Kanat F, Yosunkaya A, Çelik Ç, Çelik J, Özer F. Gebelikte ritodrin’e ba¤l› akut pulmoner ödem: Bir olgu sunusu. Akci¤er Arflivi: 2001; 4: 161-4.
2. 2. Wischnik A. Risk-benefit assessment of tocolytic drugs. Drug Safety 1991; 6: 371-80.
3. 3. Bader AM, Boudier E, Martinez C, Langer B, Sacrez C, Cherif Y, Messier M, Schlaeder G. Etiology and prevention of pulmonary complications following beta-mimetic mediated tocolysis. Eur J Obstet Gynecol and Reprod Biol 1998; 80: 133-7.
4. 4. Pisani RJ, Rosenow EC. Pulmonary edema associated with tocolytic therapy. Ann Intern Med 1989; 110: 714-8.
5. 5. Frankel S. Drug induced lung disease. Hanley E, Welsh H. Diagnosis & treatment in pulmonary medicine. New york, Lange Medical Books/ McGraw Hill, 2003. 337-47.
6. 6. Zitnik R. Drug induced lung disease due to nonchemothepeutic agents. Fishman P, Elias J, Fishman J. Fishman’s pulmonary diseases and disorders, New York, McGraw Hill, 1998; 1017-33.
7. 7. Armson BA, Samuels P, Miller F, Verbalis J, Main EK. Evaluation of maternal fluid dynamics during tocolytic therapy with ritodrine hydrochloride and magnesium sulfate. Am J Obstet Gynecol 1992; 167: 758-65
8. 8. Perry KG, Momson JC, Rust OA, Sullivan CA, Martin RW, Naef RW. Incidence of adverse cardiopulmonary effects with low-dose continuous terbutaline infusion. Am J Obstet Gynecol 1995; 173: 1273-7.

9. 9. Jartti T, Kaila T, Tahvanainen K, Kuusela T, Vanto T, Valimiki I. The acute effects of inhaled salbutamol on the beat-to-beat variability of heart rate and blood pressure assessed by spectral analysis. Br J Clin Pharmacol 1997; 43: 421-8.
10. 10. Jartti T, Kuusela TAS, Kaila TJ. Tahvanainen KUO. Valimaki IAT. The dose-response effects of terbutaline on the variability, approximate entropy and fractal dimension of heart rate and blood pressure. Br J Clin Pharmacol 1998; 45: 277-85.
11. 11. Gezginç K, Gezginç T, Gül M, Kanat F, Akyürek C. Preterm Eylemde Ritodrin Kullan›m›na Ba¤l› Nonkardiyojenik Pulmoner Ödem. Turkiye Klinikleri J Gynecol Obst 2004; 14: 283-6.