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Pulmonary edema (PE) after postpartum hemorrhage (PPH) resuscitation is mainly due to fluid overload or transfusion-related acute lung injury. Here we present the case of a 30-year-old primigravida having uncomplicated twin pregnancy. She developed PPH and PE simultaneously during the early postpartum period. Chest radiography was inconclusive to exclude fluid overload. Echocardiography and lung ultrasound ruled out volume overload. PE could be due to adverse effects of drugs, or negative pressure from laryngospasm originating from incisional pain during uterine manipulation. Caution should be exercised while administering methylergometrine or carboprost for atonic PPH, with continued vigilance for detection of signs of PE, especially in high-risk pregnancy. Moreover, the risk versus benefit ratio should be considered for performing abdominal uterine massage as it may be more harmful than beneficial in such subset of patients.

Postpartum pulmonary edema in twin parturient: beyond the fluids