Shaikh Nissar, Nawaz Shoaib, Chanda Arshad, Nahid Seema, Zubair Muhmmad, Ummunnisa Firdous
Department of Anesthesia/SICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.
Department of OBGY, Hamad Medical Corporation, Doha, Qatar.
Case Rep Obstet Gynecol. 2020 Sep 8;2020:8862839. doi: 10.1155/2020/8862839. eCollection 2020.
Eclampsia is associated with high maternal and fetal morbidity and mortality. The mortality in eclampsia is reported to be secondary to cerebrovascular accidents, neurogenic pulmonary edema, or acute kidney injury leading to cardiac arrest. A rarely reported etiology is sudden cardiac arrest (SCA) immediately after the seizure activity. We report a case of morbidly obese multigravida, complicated into postnatal eclampsia developing postseizure SCA due to apnea. . A 35-year-old woman in 38 weeks of gestation presented to the women's hospital emergency with hypertension and proteinuria and had lower section caesarean section under epidural anesthesia and required labetalol infusion. She developed convulsions in the 1st postoperative day, and she was started on magnesium sulphate therapy. After a few minutes, the patient had a 2nd episode of convulsions, apnea, cyanosis, and cardiac asystole requiring cardiopulmonary resuscitation and spontaneous circulation returned in 3 minutes. Her endotracheal intubation was difficult, but we succeeded in the 2nd attempt. She was sedated, ventilated, and required noradrenaline to maintain hemodynamics. Her ECG, echocardiogram, cardiac biomarkers, CT chest/brain, and serum magnesium levels were within normal range. The patient was weaned from vasopressor and ventilator by day 2 and extubated. She became awake; labetalol and magnesium sulphate infusions were stopped by day 3. The patient was transferred to the ward on day 5; from there she was discharged home on day 8 on oral labetalol. She was followed up in an outpatient clinic after 4 weeks and remained comfortable, and blood pressure was controlled with tablet labetalol and repeat echocardiogram was normal. . Eclampsia patients can have apnea after seizures, progressing to SCA.
子痫与孕产妇和胎儿的高发病率及死亡率相关。据报道，子痫的死亡率继发于脑血管意外、神经源性肺水肿或导致心脏骤停的急性肾损伤。一种罕见的病因是癫痫发作活动后立即发生的心搏骤停（SCA）。我们报告一例极度肥胖的经产妇病例，该患者产后并发子痫，因呼吸暂停在癫痫发作后发生SCA。一名38周妊娠的35岁女性因高血压和蛋白尿就诊于妇产科医院急诊科，在硬膜外麻醉下行剖宫产术，术后需要静脉输注拉贝洛尔。术后第1天她出现惊厥，开始接受硫酸镁治疗。几分钟后，患者再次出现惊厥、呼吸暂停、发绀和心搏停止，需要进行心肺复苏，3分钟后恢复自主循环。她的气管插管困难，但第二次尝试成功。她接受镇静、机械通气，需要去甲肾上腺素维持血流动力学稳定。她的心电图、超声心动图、心脏生物标志物、胸部/脑部CT以及血清镁水平均在正常范围内。患者在第2天停用血管升压药并撤离呼吸机，随后拔管。她苏醒过来；第3天停止输注拉贝洛尔和硫酸镁。患者于第5天转至病房；第8天口服拉贝洛尔后出院回家。4周后在门诊随访，她情况良好，服用拉贝洛尔片剂血压得到控制，复查超声心动图正常。子痫患者癫痫发作后可出现呼吸暂停，进而发展为SCA。
