Unilateral Pulmonary Edema Associated With Prolonged Lateral Decubitus Positioning During Tocolytic Therapy in Pregnancy: A Case Report

TL;DR

A pregnant woman developed one-sided lung fluid likely due to drug use and lying on her side for too long, highlighting the need for careful positioning during treatment.

Contribution

Identifies a rare case linking unilateral pulmonary edema in pregnancy to prolonged lateral positioning and tocolytic therapy.

Findings

Unilateral pulmonary edema in a pregnant woman was associated with prolonged left lateral decubitus positioning.

Drug-induced pulmonary edema combined with positioning may cause atypical radiologic findings.

Early recognition of positional effects can aid in timely diagnosis and treatment.

Abstract

Peripartum pulmonary edema is rare but potentially life-threatening for both the mother and fetus. Unilateral pulmonary edema is particularly uncommon and can mimic pneumonia, delaying appropriate diagnosis because of atypical radiologic findings. A 28-year-old pregnant woman (G3P1) hospitalized for threatened preterm labor received ritodrine hydrochloride and magnesium sulfate. At gestational week 25, she suddenly developed chest pain, dyspnea, and hypoxemia. Chest X-ray revealed unilateral, left-sided pulmonary infiltrates. Cardiac evaluation showed no evidence of cardiogenic pulmonary edema, and infection was excluded, suggesting drug-induced pulmonary edema. Tocolytic agents were discontinued; however, respiratory failure necessitated emergency cesarean delivery. Postoperatively, pulmonary edema rapidly improved with intensive care. A detailed history revealed prolonged left lateral decubitus positioning before symptom onset. Drug-induced pulmonary edema combined with prolonged lateral positioning may predispose pregnant women to unilateral pulmonary edema. Awareness of positional effects during tocolytic therapy is important for early diagnosis.

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