To Determine the Frequency of Thrombocytopenia in Pre Eclamptic Presented at Isra University Hospital

Objective: To determine the frequency of thrombocytopenia in pre-eclamptic women presented at Isra University Hospital Hyderabad. Patients and Methods: This cross sectional descriptive study of six months study was conducted at Isra university hospital from April 2019 to September 2019. All the patients between ≥18 - 45 years of age diagnosed preeclampsia were admitted and evaluated for thrombocytopenia. Results: During six month study period, total of 177 patients with preeclampsia were evaluated for thrombocytopenia. The majority of patients were from urban areas 125/177 (70.6%). The mean ±SD for maternal and gestational age of the preeclamptic patient was 32.75±8.85 and 28.75±7.63 whereas the mean platelet count was 93200±10.74 respectively. The majority of the patients were 21-30 years of age (54.8%) and the finding was statistically significant with gestational age [p=0.002]. The thrombocytopenia was observed in 99/177 (55.9%) and is statistically with relation to maternal age, gestational age and parity while in context to gravida and duration of disease it is non significant. Conclusion: A significantly high frequency of thrombocytopenia (55.9%) was recorded in the patients with preeclampsia and is statistically with relation to maternal and gestational age and parity.

Perioperative Management in Parturient with Severe Preeclampsia, Obesity, and COVID-19

<p>The elevated cases of pregnant women infected with COVID-19 who needed to undergo caesarean section is a great challenge to anesthesiologists. Morbid obesity and preeclampsia in pregnancy are also another challenge to medical practice especially when the patient requires caesarean section. To describe the perioperative management of a morbidly obese preeclamptic patient with COVID-19. A pregnant woman with mild case of COVID-19, severe preeclampsia and obesity underwent an emergency caesarean section. Spinal anesthesia was performed using a Whitacre 26G spinal needle with 76 mm length, bupivacaine 0.5% 12.5 mg as spinal anesthesia agent and fentanyl 25 mcg as adjuvant. All operating teams use PPE according to COVID-19 guidelines and standard procedures. The operation went with a good outcome without any transmission to the operating team. The patient underwent treatment without postoperative complications. Spinal anesthesia is considered safe to be a usual technique for parturient with preeclampsia and morbid obesity. A proper COVID-19 surgery protocol is crucial in order to protect health workers handling COVID-19 patients.</p>

Successful Management of a Complicated Mirror Syndrome: A Case Presentation

Mirror syndrome is a rare but serious condition of pregnancy characterized by fetal hydrops of any cause and maternal edema that has severe maternal and fetal morbidity and mortality. In most cases, the pregnancy should be terminated to resolve the symptoms. Some cases with mirror syndrome resolve spontaneously due to the demise of the hydropic fetus or fetal infection with parvovirus. This case is a rare complicated mirror syndrome that managed conservatively up to 34 weeks and 3 days of gestation. This case was a unique Dichorionic Diamniotic (DCDA) twin pregnancy with mirror syndrome, that feticide of the hydropic fetus has resolved symptoms of mirror syndrome. Although the mother’s liver enzyme increased after 3 weeks of feticide, we managed to save pregnancy by conservative treatment until 34 weeks and 3 days of gestation. Finally, the mother had a cesarean section delivery. The baby is now 6 months old with normal neurodevelopmental parameters. This case suggests that preeclampsia can happen after feticide due to twin pregnancy and the retained placenta. If we consider this event, we can manage pregnancy conservatively as a preeclamptic patient.

Preeclampsia-Associated Multivessel Spontaneous Coronary Artery Dissection

Pregnancy-associated spontaneous coronary artery dissection (PASCAD) accounts for less than 5% of spontaneous coronary artery dissection cases and is comparatively more fulminant or clinically aggressive. Several factors associated with PASCAD include black ethnicity, multiparity, hypertension, advanced maternal age, and age at first childbirth. This atypical case highlights a preeclamptic patient presenting with an ST-segment elevation myocardial infarction in which multivessel dissection of both the left anterior descending and right coronary arteries were deemed co-culprit lesions for the index event.

Preeclampsia Problem-Based Learning Discussion

This chapter is a problem based learning discussion about the hypertensive diseases in pregnancy and describes incidence, risk factors, etiology, prevention and treatment of the disease. The chapter discusses risk factors for preeclampsia, the etiology and pathogenesis of preeclampsia; prevention of preeclampsia; management of preeclamptic patients; treatment of hypertension in pregnancy; eclampsia prevention and treatment; anesthetic management, including general anesthesia, of the preeclamptic patient; invasive monitoring in the preeclamptic patient; and management of HELLP syndrome. The chapter uses the case study of a 32-year-old woman at 39 weeks gestation who presents to the labor floor with headache, blurry vision, and abdominal pain for 1 day.

Relationship between severity of hypertension and renal impairment in preeclampsia

<p class="Abstract">The aim of this study was to determine the relationship between the severity of hypertension and renal impairment in preeclampsia. This study was conducted on 92 diagnosed cases of mild (n=42) and severe (n=50) preeclampsia patients from August 2010 to July 2011. All the patients were almost identical in terms of age and socioeconomic status. The results of the study showed that the mean serum creatinine and uric acid levels were significantly high in severe preeclampsia patient compared to mild preeclampsia and both systolic and diastolic blood pressures had the positive and significant effects on the serum creatinine and uric acid levels. In conclusion, impairment of renal function has the positive and significant relationship with the severity of blood pressure in the preeclamptic patient.</p>