Acute pulmonary edema after evacuation of large uterus molar pregnancy, a case report and literature review

Background and Aim : Cardiopulmonary complications have been observed after the evacuation of benignhydatiform mole which can lead to substantial morbidity and mortality.We report a 30 years old womanwho came to our outpatient department of obstetrics and gynecology at 9 weeks gestational age with asonography which represented molar pregnancy. Evacuation of the mole was done under spinal anesthesiaas an elective procedure. 6hours after evacuation, the patient had a complaint of dyspnea. CXR showedsome reticular opacity at the field of both lungs with increased Broncho vascular marking. CT angiographyshowed pulmonary edema with sub segmental atelectasis in the base of both lungs without any pattern ofpulmonary thromboembolism. Pulmonary edema was regress by administering frusemide and conservativemanagement after 8 days of ICU admission. She was discharged on 10th post-operative day in satisfactoryand stable condition.Methods : a case report.Results : a case report.Conclusion : We concluded that the evacuation of molar pregnancy especially if the uterine size was over16weeks of gestation and the BHCG level was markedly high, could be associated with cardiopulmonarycomplications. That may be fetal. So, the attention to vital signs and careful anesthetic managements andpreoperative and postoperative optimizations are necessary for any case of molar pregnancies. At the timethat cardiopulmonary signs and symptoms are detected, first we should rule out other important differentialdiagnosis. Then for trophoblastic embolization supportive care should be done.