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