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Dr. Suchitra Pandit: Successful Management of a pregnancy in a morbidly obese women referred with eclampsia

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Dr. Suchitra Pandit: Successful Management of a pregnancy in a morbidly obese women referred with eclampsia

Primigravida Mrs.ABC with 39+4 weeks POG with severe PIH with eclampsia with maternal morbid obesity (BMI – 65.66 kg / m 2) referred from private nursing home (PNH) for further management.

She had H/O generalised clonic tonic convulsions on morning of 04/08/2015 at her home. She was taken to a PNH and from there she was referred to our institute for further management.

On admission (A & E), her vitals were:

  • Conscious but talking irrelevantly, BP = 200 /100 mm Hg, PR = 93/min, Exaggerated reflexes +
  • P/A - Obesity ++++, Full term, anterior abdominal wall very edematous (about 16 inches). FHS + heard only with USG.
  • P/V - not done.
  • Inj MgSO4 loading dose ( 4 gm ) IV over 20 min followed by Inj MgSO4 1 gm/hr for prevention further convulsions & Inj Labetalol IV infusion started to control the BP. Blood investigations sent .

Patient and relatives counselled about the complications and risks involved. Decision for Emergency LSCS taken.

Anesthetist & Neonatologist summoned. Patient was shifted to LDR-Recovery room. Finding a good IV site was a challenge as patient was very edematous .Finally an IV line Arterial line was sited & decision for general anesthesia taken in view of very high maternal BMI & edematous body. Transport incubator was kept ready. Bariatric bed was required.

Patient was shifted to OT after taking high risk consent. Shifting the patient to OT table was a difficult task due to her weight .Emergency LSCS done under GA. Two assistants were required to hold up the abdominal wall to facilitate the delivery of baby.  A live male baby (Wt.3.5 KGS) covered with thick meconium delivered, had bradycardia initially, revived spontaneously. Baby was shifted to NICU.

Mother was shifted to ICU. Inj MgSO4 continued 24 hours post-delivery. Inj Clexane 0.8 ml SC given for 3 days for thromboprophylaxis.

Dr. Falguni Parikh reviewed her for the persistently high BP and suggested addition of more antihypertensives .Patient had c/o blurring of vision but fundoscopy was within normal limits as suggested by Dr Niren Dongre.

POD – 4: patient was mobilized out of bed with the help of six attendants and Foley s catheter was removed. Dressing changing was not easy.  Weight: 146 KGS on POD 4 .There was a suspected  ‘Posterior reversible encephalopathy syndrome’( PRES ) but patient made a dramatic recovery in the next two days  with conservative management

On POD - 5, patient was shifted out of ICU to the ward in hemodynamically stable condition. Baby in NICU x 6 days .Mother discharged on day 7 wound healthy Team efforts, timely delivery, Inj.Magnesium sulphate and vigilant monitoring with early mobilization  have helped

Congratulations to my team Dr.Jatinder,Dr.Saumya Anesthesia Dr.Swapna, Dr.Mohan & Dr.Sarin from, A&E team led by Dr.Samir Rathi , Dr.Falguni Parikh, Dr.Niren Dongre, Dr.Sachin Mishra, the entire ICU team led by Dr.Vatsal Kothari and our theatre staff Sr.Baby & Sr.Mridula. and Neonatology team Dr.Vinay, Dr.Preetha, Dr.Tanushree

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