August 23rd, 2019

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Maternal Death After Administration of Intravenous Labetalol to an Asthmatic Patient: A Case Report
Authors:  Whitney A. Booker, M.D., Soledad Jorge, M.D., Dena Goffman, M.D., Richard L. Berkowitz, M.D., Alexander M. Friedman, M.D., and Mary E. D’Alton, M.D.
BACKGROUND: Asthma and hypertension are commonly encountered during pregnancy. While labetalol is a first-line treatment for hypertension in pregnancy, it is contraindicated for asthmatic pregnant patients secondary to concern for bronchospasm risk.

CASE: A multiparous woman at term presented with chest tightness and was found to have severe-range blood pressures secondary to a presumptive diagnosis of preeclampsia. The patient was administered intravenous labetalol and shortly thereafter developed respiratory distress and was intubated. Given that the patient was difficult to ventilate, there was concern for bronchospasm and the patient received steroids, a beta agonist, and epinephrine. After emergent cesarean delivery, recordable maternal blood pressure or pulse could not be obtained, and advanced cardiovascular life support was initiated. After prolonged hypoxia the patient was resuscitated and transferred to the intensive care unit. On postoperative day 10 she was declared brain dead due to anoxic brain injury, and care was withdrawn.

CONCLUSION: Labetalol should be avoided in obstetric patients with asthma.
Keywords:  asthma, labetalol, maternal death, preeclampsia, pregnancy, pregnancy complications, pregnancy induced hypertension
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