Coming Out of Danger

Dealing with a tricky case of Peripartum
Cardiomyopathy

THE CASE

A 32-year old pregnant lady with 39 weeks of gestation was admitted in Nanavati Super Speciality Hospital while experiencing sudden onset of breathlessness and dry cough. The patient was a known case of Hepatitis B and Hypothyroidism. On arrival in the hospital, the patient was in acute hypoxic cardio-respiratory failure with LVEF- 25%, pulmonary edema, mixed acidosis and positive cardiac markers.

THE PROCEDURE

The patient was intubated and taken up for emergency caesarean section in view of foetal distress. Post operatively, her overall condition deteriorated with increase in metabolic lactic acidosis, increased pulmonary edema and low urine output. She was then supported with diuretic drip and bicarbonate infusion. But eventually she developed profound hypotension, vaginal bleed and experienced a drop in haemoglobin from 14% to 7% gm.

Her blood pressure was very low for which she was started on medication to maintain a good perfusion to all the organs. On future investigation, it was seen that there were multiple blood clots in both the lower limbs suggestive of DVT (Deep Vein Thrombosis). As her blood pressure was on lower side and her kidney function was also deteriorating, she was started on dialysis support. Her per vaginal bleeding was controlled by medicines.

Post-surgery, the major clinical dilemma was to continue blood thinners in the face of ongoing bleeding and recent surgery. Over the next 48 hours, her blood pressure and her urine output started improving, hence, the dialysis support and blood pressure medications could be lowered. Appropriate antibiotics were continued and her CT scan suggested higher chances of pulmonary embolism (clot in the lungs).

THE RESULT

Repeat blood tests revealed controlled infection and the patient was discharged on supportive medications and regular follow-up.

Dr. Abdul Samad Ansari
Director
Critical Care Services
Nanavati Super Speciality
Hospital, Mumbai


Dr. Rajendra M. Saraogi
Consultant- Obstetrician &
Gynaecologist
Gynaecology & Obstetrics
Nanavati Super Speciality
Hospital, Mumbai