[Non-invasive ventilation for pulmonary edema associated with tocolytic agents during labour for a twin pregnancy]. / Ventilation non-invasive pour oedème pulmonaire attribué aux tocolytiques lors du travail d'une grossesse gémellaire.

OBJECTIVE: To describe the efficacy and patient acceptance of non-invasive ventilation for pulmonary edema associated with administration of tocolytic drugs during labour of a twin pregnancy. CLINICAL FEATURES: We report the case of a 31-yr-old parturient at 34 weeks gestation of a twin pregnancy, who experienced acute pulmonary edema after tocolytic treatment with nifedipine, nicardipine and atosiban of > 48 hr in duration. This patient presented with hypoxia during labour and non-invasive ventilation was successfully used allowing delivery by vaginal approach, with patient-controlled epidural analgesia, of two twins with a five minute Apgar score of 8. Investigations showed acute pulmonary edema and important transudate pleural effusions with left ventricular systolic dysfunction induced by calcium-antagonist, with favourable outcome after symptomatic treatment. CONCLUSION: When pulmonary edema occurs during pregnancy, non-invasive ventilation could be an efficacious treatment, this avoiding tracheal intubation and its complications.

Laparoscopic management of a ruptured benign dermoid cyst during advanced pregnancy.

Benign cystic teratomas in pregnant women may be responsible for complications such as torsion, rupture and obstruction of labor. A woman in her 31st week of pregnancy with torsion of a large dermoid cyst and lipogranulomatosis peritonitis due to spilled cyst contents was managed laparoscopically with a favorable outcome. Trocar sites were selected according to the uterine size. Open laparoscopy allowed protection of the gravid uterus from penetrative injuries. Laparoscopic management of a voluminous adnexal mass may be safely performed during advanced pregnancy.