Pulmonary oedema during intravenous tocolysis with fenoterol: a case report

Background
Tocolysis is a therapeutic approach designed to delay pre-term delivery for at least 48 hours, allowing for the administration of antenatal corticosteroids, which significantly reduce the risk of neonatal complications associated with prematurity. Despite its benefits, tocolytic medications can lead to rare but serious maternal and fetal side effects, necessitating careful monitoring and prompt intervention.

Case presentation
We describe the case of a 44-year-old Caucasian primiparous woman at 32 weeks gestation with a twin diamniotic dichorionic pregnancy conceived via in-vitro fertilization. She was admitted to the maternity ward due to uterine contractions. Tocolysis was initiated with the beta-adrenergic agent fenoterol. However, the patient exhibited symptoms of drug intolerance, including maternal discomfort. Simultaneously, fetal cardiotocography (CTG) revealed decelerations and tachycardia in both fetuses, prompting an emergency cesarean section. Two healthy daughters were delivered without immediate complications. Postoperatively, the patient developed pulmonary oedema and pneumonia, both of which were successfully treated with appropriate medical management.

Conclusions
This case highlights the importance of recognizing and managing adverse reactions to tocolytic drugs to safeguard maternal and fetal health. It emphasizes the need for precise monitoring during tocolysis and addresses challenges specific to twin pregnancies, such as optimal corticosteroid dosing and administration. Additionally, it underscores the critical role of individualized care in managing high-risk pregnancies to ensure favorable outcomes for both the mother and her newborns.