Mutiar Airi, Abbas Kun A
Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Narra J. 2025 Aug;5(2):e1643. doi: 10.52225/narra.v5i2.1643. Epub 2025 Apr 21.
Preeclampsia and eclampsia remain significant contributors to maternal and perinatal mortality. Managing these conditions is particularly challenging in remote areas in many islands of Indonesia, where access to medical care is severely limited. The aim of this study was to analyze the pre-hospital anesthetic management of an eclampsia patient during maritime evacuation to a higher-level facility, highlighting the complexities of medical transport in resource-limited settings. A 38-year-old multiparous woman from a remote village on Pagerungan Island, Indonesia, at 37 weeks of gestation, presented with tonic-clonic seizures consistent with eclampsia. The absence of antenatal care necessitated urgent intervention. Upon presentation, the patient had a Glasgow Coma Scale (GCS) score of 5, tachycardia, and irregular breathing, requiring rapid-sequence intubation and magnesium sulfate administration. Given the geographic constraints, the patient was evacuated by sea under challenging conditions. Despite significant waves, a multidisciplinary team successfully performed an emergency cesarean section onboard, delivering a male infant who required neonatal resuscitation. Postoperatively, both mother and neonate were transferred to a higher-level facility. However, engine failure extended the journey to 18 hours, leading to depletion of oxygen and essential medications, necessitating critical decision-making. This case underscores the significant challenges of emergency eclampsia management in remote settings, particularly during maritime evacuation. Effective stabilization, anesthesia, monitoring, and timely transport are crucial. This case highlights the need for optimized evacuation protocols and increased healthcare resource allocation to enhance maternal and neonatal outcomes in maritime and other resource-limited settings.
子痫前期和子痫仍然是孕产妇和围产期死亡的重要原因。在印度尼西亚许多岛屿的偏远地区，管理这些病症尤其具有挑战性，因为这些地区获得医疗护理的机会极为有限。本研究的目的是分析一名子痫患者在海上转运至更高水平医疗机构期间的院前麻醉管理，突出资源有限环境下医疗运输的复杂性。一名来自印度尼西亚帕杰伦甘岛偏远村庄的38岁经产妇，妊娠37周时出现与子痫相符的强直阵挛性发作。由于未进行产前检查，需要紧急干预。就诊时，患者格拉斯哥昏迷量表（GCS）评分为5分，心动过速，呼吸不规则，需要快速顺序插管并给予硫酸镁。鉴于地理限制，患者在具有挑战性的条件下通过海路转运。尽管海浪很大，一个多学科团队仍在船上成功进行了紧急剖宫产，分娩出一名需要新生儿复苏的男婴。术后，母亲和新生儿均被转运至更高水平的医疗机构。然而，发动机故障使行程延长至18小时，导致氧气和基本药物耗尽，需要做出关键决策。该病例强调了在偏远地区，尤其是海上转运期间，子痫急诊管理面临的重大挑战。有效的稳定、麻醉、监测和及时转运至关重要。该病例突出了需要优化转运方案并增加医疗资源分配，以改善海上和其他资源有限环境下的孕产妇和新生儿结局。
