Authors :
Callistus Obinna Elegbua; Surajdeen Tunde Afolayan; Harold Yiralee Doneh; Angela Adaku Elegbua; Wofai Ubi; Oiseremen Samuel Ovbiagele; Kester Obiora Ezewuzie; Jerome Tunde Herbert
Volume/Issue :
Volume 9 - 2024, Issue 6 - June
Google Scholar :
https://tinyurl.com/ecksm6m6
Scribd :
https://tinyurl.com/yc5etawj
DOI :
https://doi.org/10.38124/ijisrt/IJISRT24JUN378
Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.
Abstract :
This case report examines a poignant instance
of severe preeclampsia in a 26 year old with a history of
recurrent pregnancy loss and however, a prior vaginal
delivery. The patient presented at 29 weeks gestation with
acute lower abdominal pain with associated abruptio
placentae, resulting in a stillbirth and disseminated
intravascular coagulopathy (DIC). The intricate interplay
of obstetric history and clinical management reveals the
challenges in navigating such complex scenarios.
The patient's obstetric history of recurrent
miscarriages and a vaginal delivery with perineal tear
signals a predisposition to adverse outcomes. The acute
presentation of abruptio placentae underscores the
imperative for heightened vigilance in pregnant women
even in the absence of antenatal complaints.
Successful resuscitation involved correcting shock,
transfusing three units of blood and addressing
hemorrhagic DIC. Tranexamic acid, pentazocine, normal
saline, misoprostol and oxytocin were employed to stabilize
the patient, highlighting the necessity of a comprehensive
and multidisciplinary approach.
This case serves as a stark reminder of the
unpredictable nature of severe preeclampsia and
emphasizes on the critical importance of early detection
and intervention. Future research endeavors should focus
on refining risk stratification models and exploring
innovative interventions to enhance maternal and fetal
outcomes in high-risk pregnancies.
References :
- Phipps, Elizabeth, et al. "Preeclampsia: updates in pathogenesis, definitions, and guidelines." Clinical journal of the American Society of Nephrology: CJASN 11.6 (2016): 1102.
- Gando, S., Levi, M., & Toh, C. H. (2016). Disseminated intravascular coagulation. Nature reviews Disease primers, 2(1), 1-16.
- Friedman, S. A., Taylor, R. N., & Roberts, J. M. (1991). Pathophysiology of preeclampsia. Clinics in perinatology, 18(4), 661-682.
- Ten Cate, H., Timmerman, J. J., & Levi, M. (1999). The pathophysiology of disseminated intravascular coagulation. Thrombosis and haemostasis, 82(08), 713-717.
- Oyelese, Yinka, and Cande V. Ananth. "Placental abruption." Obstetrics & Gynecology 108.4 (2006): 1005-1016.
- Tikkanen, M., Nuutila, M., Hiilesmaa, V., Paavonen, J., & Ylikorkala, O. (2006). Clinical presentation and risk factors of placental abruption. Acta obstetricia et gynecologica Scandinavica, 85(6), 700-705.
- Ananth, Cande V., Gertrud S. Berkowitz, David A. Savitz, and Robert H. Lapinski. "Placental abruption and adverse perinatal outcomes." Jama 282, no. 17 (1999): 1646-1651.
- Beune, Irene Maria, et al. "Consensus definition of fetal growth restriction in intrauterine fetal death: a Delphi procedure." Archives of pathology & laboratory medicine 145.4 (2021): 428-436.
This case report examines a poignant instance
of severe preeclampsia in a 26 year old with a history of
recurrent pregnancy loss and however, a prior vaginal
delivery. The patient presented at 29 weeks gestation with
acute lower abdominal pain with associated abruptio
placentae, resulting in a stillbirth and disseminated
intravascular coagulopathy (DIC). The intricate interplay
of obstetric history and clinical management reveals the
challenges in navigating such complex scenarios.
The patient's obstetric history of recurrent
miscarriages and a vaginal delivery with perineal tear
signals a predisposition to adverse outcomes. The acute
presentation of abruptio placentae underscores the
imperative for heightened vigilance in pregnant women
even in the absence of antenatal complaints.
Successful resuscitation involved correcting shock,
transfusing three units of blood and addressing
hemorrhagic DIC. Tranexamic acid, pentazocine, normal
saline, misoprostol and oxytocin were employed to stabilize
the patient, highlighting the necessity of a comprehensive
and multidisciplinary approach.
This case serves as a stark reminder of the
unpredictable nature of severe preeclampsia and
emphasizes on the critical importance of early detection
and intervention. Future research endeavors should focus
on refining risk stratification models and exploring
innovative interventions to enhance maternal and fetal
outcomes in high-risk pregnancies.