Pulmonary edema in obstetric patients is rapidly resolved except in the presence of infection or of nitroglycerin tocolysis after open fetal surgery.

OBJECTIVES: This study was designed to determine the etiology, course, and severity of pulmonary edema in obstetric patients in a tertiary care center. STUDY DESIGN: A retrospective study was carried out on 16,810 deliveries from University of California, San Francisco, 1985-1995. Diagnosis and severity of lung injury were defined by a 4-point system that was based on the chest radiograph, oxygenation, positive end-expiratory pressure, and lung compliance. Resolution of pulmonary edema was defined by improvement in the chest radiograph and hypoxemia (ratio of arterial oxygen tension to inspired oxygen concentration) scores or by extubation. RESULTS: Pulmonary edema developed in 86 patients, or 0.5% of all obstetric cases. It usually showed extensive air space consolidation on the chest radiograph and arterial hypoxemia. Although 43% of the patients had severe pulmonary dysfunction, the average time to resolution of pulmonary edema was 2.4 days. Only 45% of patients required admission to the intensive care unit and only 15% required intubation and positive-pressure ventilation. Patients with infection (mean of 7.2 days) or fetal surgery (mean of 3.8 days) had the most severe, protracted course. CONCLUSION: Although obstetric pulmonary edema is associated with extensive radiographic infiltrates and severe hypoxemia, resolution occurs rapidly in most patients, limiting the need for intensive care support.

Differential expression of G1 cyclins during human placentogenesis.

Cyclins are proteins that support the progression of cell-cycle stages in proliferating cells. The purpose of this study was to determine which of the cyclin genes is involved in the regulation of normal human trophoblast proliferation. The presence and cellular localization of four G1 cyclins D1, D2, D3 and E, were determined by immunohistochemistry. This analysis indicated that cyclins E and D3 are the predominant cyclins in villous trophoblast. D2 was present only within the villous core, in fetal macrophages. Positive immunoreactivity for cyclin D1 was strongest in second and third trimester placentae, in the cells lining the intravillous vessels with additional reactivity in extravillous cytotrophoblasts. Because cyclin E protein was present in a greater percentage of cells than those that are dividing, Western blot analysis was performed to validate the fidelity of the immunohistochemistry data. The results of the Western analysis revealed that two forms of cyclin E protein of the appropriate size were present. Data collected from this study suggest that within the trophoblast lineage, cyclins D3 and E are important cell cycle regulatory proteins, and further, that cyclin E may function in trophoblast terminal differentiation as well.