A primigravida at 33 weeks with pre-eclampsia with severe features develops respiratory distress after receiving aggressive crystalloid loading for epidural analgesia. SpO2 is 88 percent on room air, bilateral crepitations are present, and chest X-ray shows bat-wing opacities. Along with stopping fluids and giving oxygen, the most appropriate drug is:

• A Furosemide 20 mg IV ✓
• B Mannitol 20 percent infusion
• C Betamethasone 12 mg IM
• D Hydralazine 5 mg IV

Explanation

Pulmonary edema in severe pre-eclampsia results from low plasma oncotic pressure due to urinary protein loss combined with iatrogenic fluid overload, and capillary leak. It is treated with oxygen, fluid restriction, and a loop diuretic such as furosemide, which also lowers preload. Mannitol is contraindicated because it expands intravascular volume acutely and can worsen pulmonary edema. Betamethasone and hydralazine have no role in treating established hydrostatic pulmonary edema.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.