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Multidisciplinary Approach to Complicated Pregnancy.

Josip Andelo Borovac1, Josko Bozic1, Tina Ticinovic Kurir1

  • 1From the Department of Pathophysiology, University of Split School of Medicine, Split, the Department of Internal Medicine, University Hospital Center Split, Split, University Psychiatric Hospital Vrapce, University of Zagreb School of Medicine, Zagreb, the Clinical Department of Diagnostic and Interventional Radiology University Hospital Center Split, Split, and the Department of Gynecology and Obstetrics, University Hospital Center Split, Split, Croatia.

Southern Medical Journal
|March 4, 2017
PubMed
Summary

This case study details a rare, severe preeclampsia complication in a pregnant woman, involving HELLP syndrome and posterior reversible encephalopathy syndrome. Multidisciplinary critical care led to a successful outcome for both mother and child.

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Area of Science:

  • Obstetrics and Gynecology
  • Critical Care Medicine
  • Maternal-Fetal Medicine

Background:

  • Preeclampsia is a serious pregnancy complication characterized by high blood pressure and organ damage.
  • Early diagnosis and management are crucial for preventing severe maternal and fetal outcomes.

Observation:

  • A nulliparous woman at 32 weeks gestation presented with hypertensive emergency and proteinuria, diagnosed with preeclampsia.
  • Despite initial treatment, she developed imminent eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome, and acute respiratory distress syndrome.
  • The patient required emergent cesarean delivery and intensive care unit admission due to rapid deterioration.

Findings:

  • The case illustrates a rare cascade of life-threatening conditions including preeclampsia, eclampsia, HELLP syndrome, PRES, and ARDS.
  • Magnetic resonance imaging confirmed posterior reversible encephalopathy syndrome, while chest x-ray showed diffuse bilateral infiltrates indicative of ARDS.

Implications:

  • This case highlights the importance of vigilant monitoring and multidisciplinary decision-making in managing complex obstetric emergencies.
  • Aggressive and timely critical care interventions are vital for achieving favorable outcomes in severe preeclampsia-related complications.
  • Successful management underscores the potential for positive maternal and neonatal survival even in the presence of multiple severe, concurrent conditions.