Acute Pulmonary Edema After Large Molar Pregnancy Uterine Evacuation
Abstract
Cardiopulmonary complications have been observed after the evacuation of benign hydatidiform mole which can lead to substantial morbidity and mortality. We report a 30-years-old woman who came to our outpatient department of obstetrics and gynecology at 9 weeks gestational age with sonography which represented molar pregnancy. Evacuation of the mole was done under spinal anesthesia as an elective procedure. The patient had a complaint of dyspnea, 6 hours after evacuation. CXR showed some reticular opacity in the field of both lungs with increased Broncho vascular marking. CT angiography showed pulmonary edema with subsegmental atelectasis in the base of both lungs without any pattern of pulmonary thromboembolism. Pulmonary edema was regressed by administering frusemide and conservative management after 8 days of ICU admission. She was discharged on the 10th postoperative day in satisfactory and stable condition.
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2. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol 1995; 86:775.
3. Braga A, Moraes V, Maestá I, et al. Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women. Int J Gynecol Cancer 2016; 26:984.
4.Berkowitz RS, Goldstein DP. Current advances in the management of gestational trophoblastic disease. Gynecol Oncol 2013; 128:3.
5.Berman ML, Di Saia PJ, Brewster WR. Pelvic malignancies, gestational trophoblastic neoplasia, and non-pelvic malignancies. In: Creasy RK, Resnick R. Maternal-Fetal Medicine. 4th ed. Philadelphia, Pa: WB Saunders Co; 1999: 1128-1150.
6. Mayur R Gandhi, Gunvant K kadikar. Acute pulmonary edema after evacuation of molar pregnancy. National journal of medical research Jan- March 2014; Volume 4, issue 1, 101-103 njmr.in/uploads/4-1_101-103.pdf
7. Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy. N Engl J Med 2009; 360:1639.
https://www.nejm.org/doi/pdf/10.1056/NEJMcp0900696
8. Tidy JA, Gillespie AM, Bright N, Radstone CR, Coleman RE, Hancock BW. Gestational trophoblastic disease: A study of mode of evacuation and subsequent need for treatment with chemotherapy. Gynecol Oncol. 2000; 78 (3 Pt 1):309–12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009886
9. Celeski D, Micho J, Walters L. Anesthetic implications of a partial molar pregnancy and associated complications. AANAJ 2001; 69:49-53.
10. Chantigan RC, Chantigan PD. Problems of early pregnancy. In: Chestnut DH, editor. Obstetric Anesthesia Principles and Practice 3 rd ed. St. Louis: Mosby; 2004. p. 241-54.
11. Twiggs LB, Morrow CP, Schlaerth JB. Acute pulmonary complications of molar pregnancy. Am J Obstet Gynecol 1979; 135:189. https://www.ncbi.nlm.nih.gov/pubmed/474670
12. Huberman RP, Fon GT, Bein ME. Benign molar pregnancies: pulmonary complications. Am J Roentgenol 1982; 138:71–74.
13. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Gestational trophoblastic disease.In:Andrea Seils, Edmonson KG, Karen Davis, Rouse DJ, Spong KY, editors. Williams Obstetrics. 22 nd Ed. New York: Mc Graw Hill publications; 2005. p. 273-84.
14. Delmis J, Pfeifer D, Ivanisevic M, Forko JI, Hlupic L. Sudden death from trophoblastic embolism in pregnancy. Eur J Obstet Gynecol Reprod Biol 2000;92:225–227.
15. Kurdi MS. Hydatidiform mole: A sour encounter with a grapy case. Indian J Anaesth 2011; 55:171-3.http://www.ijaweb.org/article.asp?issn=0019- 5049;year=2011;volume=55;issue=2;spage=171;epage=173;aulast=Kurdi
16. Dave N, Fernandes S, Ambi U, Iyer H. Hydatidiform mole with hyperthyroidism-perioperative challenges. J Obstet Gynecol India 2009; 59:356-7.
17. Carrasco C, Cotoras J. Gestational hyperthyroidism: a case associated to molar pregnancy. Rev Med Chil 2001; 129:303-6. https://www.researchgate.net/publication 11966575_Gestational_hyperthyroidism_associated_to_molar_pregnancy_A_case_report
2. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol 1995; 86:775.
3. Braga A, Moraes V, Maestá I, et al. Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women. Int J Gynecol Cancer 2016; 26:984.
4.Berkowitz RS, Goldstein DP. Current advances in the management of gestational trophoblastic disease. Gynecol Oncol 2013; 128:3.
5.Berman ML, Di Saia PJ, Brewster WR. Pelvic malignancies, gestational trophoblastic neoplasia, and non-pelvic malignancies. In: Creasy RK, Resnick R. Maternal-Fetal Medicine. 4th ed. Philadelphia, Pa: WB Saunders Co; 1999: 1128-1150.
6. Mayur R Gandhi, Gunvant K kadikar. Acute pulmonary edema after evacuation of molar pregnancy. National journal of medical research Jan- March 2014; Volume 4, issue 1, 101-103 njmr.in/uploads/4-1_101-103.pdf
7. Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy. N Engl J Med 2009; 360:1639.
https://www.nejm.org/doi/pdf/10.1056/NEJMcp0900696
8. Tidy JA, Gillespie AM, Bright N, Radstone CR, Coleman RE, Hancock BW. Gestational trophoblastic disease: A study of mode of evacuation and subsequent need for treatment with chemotherapy. Gynecol Oncol. 2000; 78 (3 Pt 1):309–12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009886
9. Celeski D, Micho J, Walters L. Anesthetic implications of a partial molar pregnancy and associated complications. AANAJ 2001; 69:49-53.
10. Chantigan RC, Chantigan PD. Problems of early pregnancy. In: Chestnut DH, editor. Obstetric Anesthesia Principles and Practice 3 rd ed. St. Louis: Mosby; 2004. p. 241-54.
11. Twiggs LB, Morrow CP, Schlaerth JB. Acute pulmonary complications of molar pregnancy. Am J Obstet Gynecol 1979; 135:189. https://www.ncbi.nlm.nih.gov/pubmed/474670
12. Huberman RP, Fon GT, Bein ME. Benign molar pregnancies: pulmonary complications. Am J Roentgenol 1982; 138:71–74.
13. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Gestational trophoblastic disease.In:Andrea Seils, Edmonson KG, Karen Davis, Rouse DJ, Spong KY, editors. Williams Obstetrics. 22 nd Ed. New York: Mc Graw Hill publications; 2005. p. 273-84.
14. Delmis J, Pfeifer D, Ivanisevic M, Forko JI, Hlupic L. Sudden death from trophoblastic embolism in pregnancy. Eur J Obstet Gynecol Reprod Biol 2000;92:225–227.
15. Kurdi MS. Hydatidiform mole: A sour encounter with a grapy case. Indian J Anaesth 2011; 55:171-3.http://www.ijaweb.org/article.asp?issn=0019- 5049;year=2011;volume=55;issue=2;spage=171;epage=173;aulast=Kurdi
16. Dave N, Fernandes S, Ambi U, Iyer H. Hydatidiform mole with hyperthyroidism-perioperative challenges. J Obstet Gynecol India 2009; 59:356-7.
17. Carrasco C, Cotoras J. Gestational hyperthyroidism: a case associated to molar pregnancy. Rev Med Chil 2001; 129:303-6. https://www.researchgate.net/publication 11966575_Gestational_hyperthyroidism_associated_to_molar_pregnancy_A_case_report
| Files | ||
| Issue | Vol 57, No 9 (2019) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/acta.v57i9.2642 | |
| Keywords | ||
| Molar pregnancy Gestational trophoblastic disease Pulmonary edema Trophoblastic embolism Cardiopulmonary symptoms Molar evacuation Uterine suction | ||
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How to Cite
1.
Abbasi H, Behforouz A. Acute Pulmonary Edema After Large Molar Pregnancy Uterine Evacuation. Acta Med Iran. 2020;57(9):565-568.
