Acute pulmonary edema secondary to severe preeclampsia in a 47-year old elderly gravida conceived via in vitro fertilization: a case report

Madhumitha Venkatesh; Sneha Mathimaaran; Palaniappan Narayanan

doi:10.18203/2320-1770.ijrcog20253118

Authors

Madhumitha Venkatesh Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India https://orcid.org/0009-0006-1237-065X
Sneha Mathimaaran Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India https://orcid.org/0009-0001-0766-6062
Palaniappan Narayanan Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253118

Keywords:

Preeclampsia, Acute pulmonary edema, In vitro fertilization, Elderly primigravida, Multidisciplinary care, Lower segment caesarean section

Abstract

Advanced maternal age and assisted reproductive technologies, such as in vitro fertilization (IVF) with oocyte donation, are recognized as risk factors for many disorders in pregnancy, including preeclampsia. Severe preeclampsia can, in rare instances, be complicated by acute pulmonary edema, posing significant risks to both the mother and the fetus. We report a rare case of a 47-year-old elderly primigravida with a BMI of 30 kg/m² (obese) who conceived via IVF and developed severe preeclampsia at 30+5 weeks of gestation with a hypertensive crisis that progressed to cause a life-threatening acute pulmonary edema. Immediate management included intravenous antihypertensives, diuretics, magnesium sulphate, and ventilatory support. Due to the deteriorating maternal and fetal status, an emergency lower segment caesarean section was performed in the intensive care unit. A 1.2 kg baby girl was delivered and admitted to the neonatal intensive care unit. The mother showed gradual postoperative improvement with stabilization of blood pressure and resolution of pulmonary symptoms. Her recovery period was aided by a multidisciplinary team involving obstetricians, anaesthesiologists, neonatologists, intervention specialists, and clinical psychologists. The case emphasizes the need for heightened vigilance and aggressive management in IVF pregnancies especially among women of advanced maternal age who are at increased risk of hypertensive disorders, fluid shifts, and cardiovascular stress. Risk assessment in elderly women undergoing IVF is crucial, along with vigilant monitoring and prompt multidisciplinary intervention to improve outcomes in high-risk pregnancies.

Metrics

Metrics Loading ...

References

Fox R, Kitt J, Leeson P, Aye CYL, Lewandowski AJ. Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. J Clin Med. 2019;8(10):1625. DOI: https://doi.org/10.3390/jcm8101625

Kaur H, Kolli M. Acute pulmonary edema in pregnancy-fluid overload or atypical pre-eclampsia. Cureus. 2021;13(11):19305. DOI: https://doi.org/10.7759/cureus.19305

Nathaniel F, Dinata F. Acute postpartum pulmonary edema in severe preeclampsia. Science Midwifery. 2023;10(6):4692-7.

Nijkamp MD, Oldenbroek A, Dijkstra J, Bakker EC. The (un) informed patient: a comparative study of anxiety and sense of control in primary and secondary caesarean sections. J Med Res Health Edu. 2017;1(3):14.

Shah A, Parisaei M, Garner J. Obstetric Complications of Donor Egg Conception Pregnancies. J Obstet Gynaecol India. 2019;69(5):395-8. DOI: https://doi.org/10.1007/s13224-019-01211-9

Sauer MV, Paulson RJ, Lobo RA. Oocyte donation to women of advanced reproductive age: pregnancy results and obstetrical outcomes in patients 45 years and older. Hum Reprod. 1996;11(11):2540-3. DOI: https://doi.org/10.1093/oxfordjournals.humrep.a019155

Maskan Bermudez N, Elman SA, Kirsner RS, Lev-Tov H. Management of hidradenitis suppurativa in the inpatient setting: a clinical guide. Arch Dermatol Res. 2025;317(1):202. DOI: https://doi.org/10.1007/s00403-024-03622-9

Ram M, Anteby M, Weiniger CF, Havakuk O, Gilboa I, Shenhav M, et al. Acute pulmonary edema due to severe preeclampsia in advanced maternal age women. Pregnancy Hypertens. 2021;25:150-5. DOI: https://doi.org/10.1016/j.preghy.2021.05.019

Souabni SA, Belhaddad EH, Oubahha I, Nejmaddine K, Aboulfalah A, Soummani A. Preeclampsia complicated with pulmonary edema: a case report. PAMJ Clin Med. 2020;4(103):103. DOI: https://doi.org/10.11604/pamj-cm.2020.4.103.26497

Jim B, Karumanchi SA. Preeclampsia: pathogenesis, prevention, and long-term complications. Sem Nephrol. 2017;37(4):386-97. DOI: https://doi.org/10.1016/j.semnephrol.2017.05.011

Devi DS, Kumar BJ. A case of severe preeclampsia presenting as acute pulmonary oedema. Int J Reprod Contracept Obstet Gynecol. 2016;5:899-902. DOI: https://doi.org/10.18203/2320-1770.ijrcog20160608

Sibai BM, Mabie BC, Harvey CJ, Gonzalez AR. Pulmonary edema in severe preeclampsia-eclampsia: analysis of thirty-seven consecutive cases. Am J Obstet Gynecol. 1987;156(5):1174-9. DOI: https://doi.org/10.1016/0002-9378(87)90135-9

Dennis AT, Solnordal CB. Acute pulmonary oedema in pregnant women. Anaesthesia. 2012;67(6):646–59. DOI: https://doi.org/10.1111/j.1365-2044.2012.07055.x