Journal of Health and Medical Sciences
Published: 18 August 2020
Case Report: Intensive Care Management of Preeclampsia and HELLP Syndrome
Muchammad Erias Erlangga, Erwin Pradian, Suwarman, Reza Widianto Sudjud
Universitas Padjajaran, Indonesia
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Keywords: Anesthesia Management, Sectio Caesarea, Preeclampsia, Eclampsia
Introduction: Preeclampsia, eclampsia, and HELLP syndrome are life-threatening conditions in 2-8% of pregnant women and result in 70,000 maternal deaths and 50,000 infant deaths worldwide. Preeclampsia, eclampsia, and HELLP syndrome with organ failure are indications for intensive care in pregnant women. The most important goal of management of patients with preeclampsia is to prevent eclampsia and reduce maternal blood pressure. Case: A 35 year old woman with G3P2A0 gravida 29-30 weeks with impending eclampsia who underwent caesarean section. The history revealed complaints of severe headache, blurry vision, heartburn, and a history of high blood pressure during this pregnancy. On the examination of vital signs, the blood pressure was 160/100 mmHg. In laboratory examination, the results of proteinuria (+3) and other results were within normal limits. Preoperative management of intravenous magnesium sulfate, with the oral antihypertensive Methyldopa. Intraoperative general anesthesia was performed, the operation lasted 1 hour, the total bleeding was 250 cc. Postoperatively the patient was transferred to the semi-intensive room (HCU), the patient experienced worsening due to uterine atony. After being resuscitated and intubated, the patient was performed relaparotomy and hysterectomy under general anesthesia. The operation lasts for 2 hours. The patient is then transferred to the intensive care unit (ICU) for close observation. Conclusion: Determination of the basic diagnosis and appropriate initial management and prevention of complications in preeclampsia, eclampsia, and HELLP syndrome can reduce the incidence of morbidity and mortality.
Altenstadt, J.F.V.S.A., Hukkelhoven, C.W.P.M., Roosmalen, J.V., & Bloemenkamp, K.W.M. (2013). Pre-Eclampsia Increases the Risk of Postpartum Hemorrhage: A Nationwide Cohort Study in The Netherlands. PLoS One, 8(12), e81959. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0081959
Jeyabalan, A., (2014). Epidemiology of Preeclampsia: Impact of Obesity. Nutr Rev, 71(01), 1111. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871181/
Kelsey, J. J., (2015). Obstetric Emergencies in The ICU. The Journal of the American College of Clinical Pharmacy, 7, 7-18. https://www.accp.com/docs/bookstore/psap/p7b02sample01.pdf
Lam, M. T. C., & Dierking, E. (2017). Intensive Care Unit Issues in Eclampsia and HELLP Syndrome,. Int J Crit Illn Inj Sci, 7(3), 136-41. https://pubmed.ncbi.nlm.nih.gov/28971026/
Lambert, G., Brichant, J.F., Hartstein, G., Bonhomme, V., & Dewandre, P. Y. (2014). Preeclampsia: An Update. Acta Anaesth. Belg., 65, 137-49. https://www.sarb.be/site/assets/files/1142/01-lambert_et_al.pdf
Lopes, J.A., & Jorge, S. (2013). The RIFLE and AKIN Classifications for Acute Kidney Injury: a Critical and Comprehensive Review. Clinical Kidney Journal, 6(1), 8-14.
Parthasarathy, S., Kumar, V.R.H., Sripiya, R., & Ravishankar, M. (2013). Anesthetic Management of a Patient Presenting with Eclampsia. Anesth Essays Res, 7(3), 307-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173542/
Prakash, J., & Ganiger, V, C. (2017). Acute Kidney Injury in Pregnancy-specific Disorders. Indian J Nephrol, 27(4), 258-70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5514821/
Roberts, J. M., August, P. A., Bakris, G., Barton, J.R. (2013). Classification of Hypertensive Disorders in Hypertension in Pregnancy. American College of Obstetricians and Gynecologists, vol 1, 13-6.
Roberts, J. M., August, P. A., Bakris, G., Barton, J.R. (2013). Establishing the Diagnosis of Preeclampsia and Eclampsia in Hypertension in Pregnancy. American College of Obstetricians and Gynecologists, vol 1, 17-20.
Roberts, J. M., August, P. A., Bakris, G., Barton, J. R. (2013). Hypertension in Pregnancy. American College of Obstetricians and Gynecologists, vol 1, 21-5.
Roberts, J. M., August, P. A., Bakris, G., Barton, J. R. (2013). Management of Preeclampsia and HELLP Syndrome in Hypertension in Pregnancy. American College of Obstetricians and Gynecologists, vol 1, 31-46.
Sahin, S., Eroglu, M., Tetik, S., & Guzin, K. (2014). Disseminated Intravascular Coagulation in Obstetrics: Etiopathogenesis and Up to Date Management Strategies. J Turk Soc Obstet Gynecol, 11(1), 42-51. https://pdfs.semanticscholar.org/a4b7/d3e24dd23eb779f46e8517cbb8d5b81594b6.pdf