• Laura H M Seinen, Sami O Simons, Miep A van der Drift, Jeroen van Dillen, Frank P H A Vandenbussche, and Fred K Lotgering.
• Universitair Medisch Centrum St. Radboud, Afd. Gynaecologie en Obstetrie, Nijmegen, the Netherlands. l.seinen@obgyn.umcn.nl
• Ned Tijdschr Geneeskd. 2013 Jan 1;157(1):A5316.

BackgroundNifedipine is used as a first choice tocolytic agent in many Dutch hospitals, but its use is discouraged in multiple gestations. Atosiban, a selective oxytocin receptor antagonist that rarely causes systemic side effects, is used as an alternative.Case DescriptionA 32-year-old primigravida with spontaneous triplet pregnancy was admitted at 33 3/7 weeks for threatened preterm labour. For tocolysis, atosiban was administered for 48 hours together with betamethasone for foetal lung maturation. One day after treatment with atosiban she developed dyspnoea caused by pulmonary oedema. After a caesarean section and furosemide treatment the pulmonary oedema resolved. Analysis showed that atosiban was a likely cause of the pulmonary oedema.ConclusionEvery patient with multiple gestation is at increased risk of pulmonary oedema. Any tocolytic agent may elicit that response, even the relatively safe atosiban.

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