Noncardiogenic pulmonary edema and invasive cardiovascular monitoring.

When a parturient develops clinical and roentgenographic evidence of pulmonary edema during labor or delivery, the obstetric staff often concludes that iatrogenic overhydration or left ventricular failure is the cause. This impression may be reinforced by increased central venous pressure measurements. Although acute respiratory failure (ARF) (non-cardiogenic pulmonary edema) is well described in the medical and surgical literature, the diagnosis is rarely, if ever, made in the obstetric patient unless aspiration pneumonitis is suspected. Unfortunately the usual historic and clinical findings do not differentiate ARF from cardiogenic pulmonary edema. The diagnosis of ARF is based on the finding of pulmonary edema in the absence of an elevated pulmonary capillary wedge pressure. As invasive cardiovascular monitoring is not usually part of the obstetrician's armamentarium, many cases of ARF may be mislabeled and mistreated as cardiogenic pulmonary edema. Four illustrative cases are presented.