Ritodrine-associated Noncardiogenic Pulmonary Edema Diagnosed by Point-of-care Ultrasound - A Case Report of Twin Gestation

Sep 28, 2026

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Ritodrine hydrochloride, a beta-adrenergic tocolytic agent, rarely triggers acute noncardiogenic pulmonary edema, especially inpatients with multiple gestations or comorbidities. A 28-year-old woman with twin pregnancy, type 1 diabetes, and hyperthyroidism developed acute respiratory distress after ritodrine infusion. Imaging demonstrated pulmonary edema, while point-of-care ultrasound showed diffuse bilateral B-lines with preserved left ventricular function and no evidence of right heart strain or inferior vena cava plethora. Emergency cesarean delivery at 31⁺⁶/⁷ weeks was followed by maternal improvement and favorable neonatal outcomes, highlighting POCUS utility for rapid, radiation-free differentiation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

IntroductIon

Case Report

Patient presentation

Diagnosis and clinical course

Management and outcome

| Case Report | | --- | | | Ritodrine‑associated Noncardiogenic Pulmonary Edema Diagnosed by Point‑of‑care Ultrasound: A Case Report of Twin Gestation Chih‑Yu Chou1, Chia‑Ching Chen2* 1Department of Obstetrics and Gynecology, Chung Shan Medical University, Taichung, Taiwan, 2Department of Emergency Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan Abstract Ritodrine hydrochloride, a beta‑adrenergic tocolytic agent, can rarely cause acute noncardiogenic pulmonary edema, particularly inpatients with multiple gestations or comorbidities. We report a case of a 28‑year‑old woman with twin pregnancy, type 1 diabetes, and hyperthyroidism that developed acute respiratory distress following ritodrine infusion. Imaging showed pulmonary edema, and point‑of‑care ultrasound (POCUS) revealed diffuse bilateral B‑lines, preserved left ventricular function, and no signs of right heart strain or inferior vena cava plethora. These findings supported a diagnosis of noncardiogenic pulmonary edema. Emergency cesarean section was performed at 31⁺⁶/⁷ weeks. Postoperatively, the patient’s respiratory status improved, and both neonates had favorable outcomes. This case demonstrates the utility of POCUS as a rapid, radiation‑free diagnostic tool for differentiating types of pulmonary edema in pregnant patients, enabling timely intervention and potentially improving maternal and neonatal outcomes. It also underscores the importance of vigilant monitoring when using beta‑mimetic tocolytics in high‑risk pregnancies. Keywords: Case report, point‑of‑care ultrasound, pulmonary edema, ritodrine, tocolysis, twin pregnancy IntroductIon Preterm labor, defined as the onset of labor before 37 weeks of gestation, is a significant cause of neonatal morbidity and mortality. Tocolytic agents are commonly administered to suppress uterine contractions, allowing time for administration of corticosteroids to enhance fetal lung maturity and, if necessary, transfer to a tertiary care center with neonatal intensive care facilities. Among the various tocolytic agents, beta‑adrenergic agonists such as ritodrine (Yutopar) have been widely used despite their association with maternal cardiovascular and pulmonary side effects. Although ritodrine has been withdrawn from the market in some countries including the United States, it remains available in parts of Asia and other regions. Pulmonary edema is a rare but potentially life‑threatening complication of beta‑mimetic tocolytic therapy, with an Received: 19‑04‑2025 Accepted: 21‑05‑2025 Available Online: 07‑ 11‑2025 | Video available on: [https://journals.lww.com/jmut](https://journals.lww.com/jmut) | | | --- | --- | | | | | Access this article online | | | Quick Response Code:
| Website:
[https://journals.lww.com/jmut](https://journals.lww.com/jmut) | | | DOI:
10.4103/jmu.JMU‑D‑25‑00047 | estimated incidence of 0.3%–4.0% of patients receiving such treatment. Risk factors for the development of tocolytic‑induced pulmonary edema include multiple gestation, underlying maternal cardiac or metabolic disease, excessive intravenous fluid administration, and concomitant use of corticosteroids. The pathophysiology is believed to involve a combination of increased cardiac output, sodium and fluid retention, and altered capillary permeability. This report presents a case of acute pulmonary edemain a pregnant woman with twins following ritodrine administration for tocolysis, emphasizing the role of point‑of‑care ultrasound (POCUS) in rapid diagnosis and the Address for correspondence: Dr. Chia‑Ching Chen, Department of Emergency Medicine, Chang Bing Show Chwan Memorial Hospital, No. 6, Lugong Road, Lugang Town, Changhua 505, Taiwan. E‑mail: c1[1g@hotmail.com](1g@hotmail.com) This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the wo

FAQs

Why can ritodrine cause noncardiogenic pulmonary edema?

Ritodrine is a beta-adrenergic tocolytic that can rarely lead to acute noncardiogenic pulmonary edema. The report indicates risk is higher with multiple gestations and comorbidities, and the mechanism is thought to involve fluid and capillary changes.

What did point-of-care ultrasound show in this case?

POCUS revealed diffuse bilateral B-lines. It also showed preserved left ventricular function and no signs of right heart strain or inferior vena cava plethora, supporting a noncardiogenic diagnosis.

How was the condition managed and what was the outcome?

Emergency cesarean section was performed at 31⁺⁶/⁷ weeks. Postoperatively, the patient’s respiratory status improved and both neonates had favorable outcomes.

Sep 28, 2026

Uploaded by acoobca