Vaginal misoprostol use for postpartum hemorrhage may precipitate pulmonary edema in patients with undiagnosed peripartum cardiomyopathy.
May signal undiagnosed peripartum cardiomyopathy before misoprostol; single case leaves open causality and practice implications.
Misoprostol, a synthetic prostaglandin E1 (PGE1) analogue, although not the first-line drug in the management of postpartum hemorrhage, is frequently used for this purpose due to its safety profile and cost-effectiveness. Cardio-pulmonary complications have been previously reported with use of prostaglandin analogues but not with misoprostol. We describe a case of pulmonary edema after the use of vaginal misoprostol for treatment of postpartum vaginal bleed in an otherwise healthy asymptomatic patient, who was later diagnosed as a case of peripartum cardiomyopathy.
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Rewari et al. (2011) studied this question.
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