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The effects of long-term infusion of fenoterol (a beta 2-sympathomimetic drug) in combination with the calcium antagonist verapamil on water balance, the renin-angiotensin-aldosterone system and antidiuretic hormone during pregnancy were studied. Within two hours of the start of infusion, plasma renin and antidiuretic hormone levels were significantly increased, but plasma aldosterone was strongly decreased. There was a concomitant marked reduction of urinary, sodium, and potassium excretion and a decreased creatinine clearance. The long-lasting reduction of urinary excretion which resulted in an elevated water retention is apparently due to other unknown factors. Results are discussed with special regard to the relationship between water balance disturbances and pulmonary edema.

During tocolytic treatment with Beta 2-Sympathomimetic drugs pulmonary edema is occasionally observed. The cause remains uncertain. Within 48 hours after the onset of treatment marked water retention is observed. The weight increases, the hemoglobin decreases the hematocrit decreases, the albumin concentration decreases, the water and sodium excretion decreases. The pathogenesis is discussed and recommendations for the management are proposed. Water retention due to tocolytic treatment in addition to the physiologic water retention of pregnancy or in addition to pre-eclampsia cortisone treatment, renal insufficiency, or treatment with intravenous infusions may lead to a hypervolemia which can no longer be compensated by diuresis and therefore can lead to pulmonary edema. A list of 10 groups of patient with a high risk is described. These require thorough observation following tocolytic treatment.