Kumari Anupma, Prasad Indira, Sahay Nishant, Kumar Rajnish, Agrawal Mukta
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India.
Department of Anesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India.
J Family Med Prim Care. 2024 Jul;13(7):2789-2791. doi: 10.4103/jfmpc.jfmpc_1469_23. Epub 2024 Jun 28.
Peripartum cardiomyopathy and hypertensive disorders of pregnancy are not very uncommon in routine practice, but when associated with abruptio placentae and significant hypotension, survival of both child and mother becomes challenging. We report a case of a 20-year-old primigravida who presented in the gynecology emergency unit of our hospital with an ejection fraction of < 20%, severe preeclampsia with abruptio placentae leading to fetal demise, and renal failure in the immediate postoperative period. Challenges faced during decision making regarding the mode of delivery and grave concerns during intraoperative and postoperative periods are discussed. In this case, prompt termination of pregnancy, various point-of-care sonographic measurements, and post-operative emergency dialysis played vital roles in the complete recovery of this patient with a failing heart and grossly jeopardized hemodynamics. Hence, multidisciplinary team-based management is crucial for managing such cases to prevent maternal mortality and morbidity.
围产期心肌病和妊娠期高血压疾病在日常临床实践中并不罕见,但当与胎盘早剥和严重低血压相关联时,母婴的存活就变得极具挑战性。我们报告了一例20岁初产妇的病例,该患者在我院妇科急诊室就诊时,射血分数<20%,重度子痫前期合并胎盘早剥导致胎儿死亡,且术后即刻出现肾衰竭。文中讨论了在分娩方式决策过程中面临的挑战以及术中及术后的严重担忧。在此病例中,迅速终止妊娠、各种床旁超声测量以及术后紧急透析对于这位心脏功能衰竭且血流动力学严重受损的患者的完全康复起到了至关重要的作用。因此,基于多学科团队的管理对于处理此类病例以预防孕产妇死亡和发病至关重要。