LETTERS TO THE EDITOR—CORRESPONDENCE Comment on the article ‘‘Acute pulmonary oedema during nicardipine therapy for premature labour. Report of five cases’’ by Vaast P., et al. [Eur J Obstet Gynecol Reprod Biol 2004;113:98–9] Dear Editors, We read with interest the report by Vaast et al. of the occurrence of acute pulmonary edema during tocolysis with intravenous nicardipine [1]. The authors suggest that the use of calcium-channel blockers (CCB) may be responsible for this life-threatening complication. However, several factors other than CCB may have favoured pulmonary edema in the reported cases: (1) Patients themselves were at high risk for cardiovascular complica- tions either because of multiple pregnancies, known to be associated with wide increase in plasma volume, or because of valvular cardiopathy; (2) Nicardipine was administered by intravenous infusion together with large fluid volumes. The volume of 0.9% saline infusion reached 1440 ml in some patients, which corresponds to almost 13 g NaCl per day!; (3) All patients also received intramuscular corticosteroids that may also favour water retention. More importantly, most of the large international experience of tocolysis with CCB is based on oral treatment with nifedipine and not with intravenous nicardipine. More than 10 randomised controlled studies have been performed with nifedipine [2], whereas the experience with IV nicardipine is based on a single trial [3]. We have also experienced three cases of pulmonary edema with intrave- nous nicardipine in our department, mainly when associated with betamimetic drugs [4]. We believe that oral nifedipine is the only CCB with suf- ficient evaluation for tocolysis and neonatal outcome and that it may still be proposed as a first line tocolytic agent. On the other hand, intravenous infusion of nicardipine should be discouraged in this indication until further evaluation. References [1] Vaast P, Dubreucq-Fossaert S, Houfflin-Debarge V, et al. Acute pulmonary oedema during nicardipine therapy for premature labour. Report of five cases. Eur J Obstet Gynecol Reprod Biol 2004;113: 98–9. [2] King JF, Flenady VJ, Papatsonis DN, Dekker GA, Carbonne B. Calcium channel blockers for inhibiting preterm labour. Cochrane Database Syst Rev 2003;1:CD002255. [3] Jannet D, Abankwa A, Guyard B, Carbonne B, Marpeau L, Milliez J. Nicardipine versus salbutamol in the treatment of premature labour. Eur J Obstet Gynecol Reprod Biol 1997;73:11–6. [4] Janower A, Carbonne B, Lejeune V, Apfelbaum D, Boccara F, Cohen A. Acute pulmonary edema during preterm labor: role of nicardipine? J Gynecol Obstet Biol Reprod, in press. B. Carbonne Department of Obstetrics and Gynecology Ho ˆpital Saint Antoine, Universite ´ Pierre et Marie Curie Paris, France Corresponding author. Tel.: +33 149282745 fax: +33 149282756 D.N. Papatsonis Department of Obstetrics and Gynecology Amphia Hospital Breda, Breda, The Netherlands V.J. Flenady Centre for Clinical Studies, Women’s and Children’s Health Mater Misericordiae Health Services, Brisbane, Australia G.A. Dekker Department of Obstetrics and Gynecology Lyell McEwin Hospital, University of Adelaide, Australia J.F. King Department of Perinatal Medicine Royal Women’s Hospital, Melbourne, Australia doi:10.1016/j.ejogrb.2004.11.038 Response to the comment on the article ‘‘Acute pulmonary oedema during nicardipine therapy for premature labour. Report of five cases’’ [Eur J Obstet Gynecol Reprod Biol 2004;113:98–9] Dear Editors, We thank Carbonne et al. for their comment on our article: Acute pulmonary oedema during nicardipine therapy for premature labour. Report of five cases [1]. www.elsevier.com/locate/ejogrb European Journal of Obstetrics & Gynecology and Reproductive Biology 120 (2005) 119–124 DOI of original article: 10.1016/j.ejogrb.2004.12.007 DOI of original article: 10.1016/j.ejogrb.2004.11.038 0301-2115/$ – see front matter # 2004 Elsevier Ireland Ltd. All rights reserved.