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Suggest Treatment For 38 Weeks Of Amenorrhea
24 years old young women with 38 weeks of amenorrhea came to hospital with history of blurring of vision. On examination BP 160/110 and she had bilateral pitting odema.immediate lscs was done.5 -6 hours after lscs exploratory laporotomy was done ,small collection of blood evacuated.her hb droppeddown post operatively. Platecount was 30000/cmm.ptinr 3.5sec. 2 units FFP & 4 units of platelet ,1 unit of blood transfused post operatively. after 3-4 hrs she started to have breathlessness for which she was shifted to icu. BP was 160/80, respiratory rate 34/mnt, pulse 156/mnt,spo2 96%.after 8 hours she died of cardiorespiratory failure.what was the cause for her death?.what should be the management in this case?
Thu, 17 Nov 2022
Hello,
The pregnant lady was brought with typical signs of preeclampsia like:
1) Blurring of vision
2) High blood pressure
3) Bilateral pitting edema of legs
Though you had delivered immediately, she must have had a poor antenatal care in regard to preeclampsia.
In my opinion, preeclampsia continued post partum leading to the following causes of death of the lady:
1) Pulmonary edema
2) Stroke
3) Thrombo-embolism
4) HELLP syndrome meaning hemolysis, elevated liver enzymes, low platelet count and leading to multiorgan failure
5) Placental abruption (maybe)
6) Cardiomyopathy
7) Respiratory acidosis leading to cardiorespiratory failure.
In this case, first of all, the lady was not taken care of antenatally and she was probably not treated for preeclampsia. She arrived with preeclampsia and HELLP syndrome. Though the baby was delivered, preeclampsia continued post partum leading to multiple organ failure and respiratory acidosis. At this stage, transfusion was given promptly but airway management was important too.
When patient is going into respiratory acidosis and acute respiratory failure, the intensivist must have intubated and given positive pressure ventilation. Non invasive ventilation like BiPAP could have been used to assist her labored breathing.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Pallavi M., Anesthesiologist
The pregnant lady was brought with typical signs of preeclampsia like:
1) Blurring of vision
2) High blood pressure
3) Bilateral pitting edema of legs
Though you had delivered immediately, she must have had a poor antenatal care in regard to preeclampsia.
In my opinion, preeclampsia continued post partum leading to the following causes of death of the lady:
1) Pulmonary edema
2) Stroke
3) Thrombo-embolism
4) HELLP syndrome meaning hemolysis, elevated liver enzymes, low platelet count and leading to multiorgan failure
5) Placental abruption (maybe)
6) Cardiomyopathy
7) Respiratory acidosis leading to cardiorespiratory failure.
In this case, first of all, the lady was not taken care of antenatally and she was probably not treated for preeclampsia. She arrived with preeclampsia and HELLP syndrome. Though the baby was delivered, preeclampsia continued post partum leading to multiple organ failure and respiratory acidosis. At this stage, transfusion was given promptly but airway management was important too.
When patient is going into respiratory acidosis and acute respiratory failure, the intensivist must have intubated and given positive pressure ventilation. Non invasive ventilation like BiPAP could have been used to assist her labored breathing.
Take care. Hope I have answered your question. Let me know if I can assist you further.
Regards,
Dr. Pallavi M., Anesthesiologist
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