Rapid Deterioration of a Post-partum Patient
Abstract Number: 117
Abstract Type: Case Report/Case Series
The practice of Obstetric Anesthesia involves extensive knowledge not only of the physiology of pregnancy but also the pathophysiologic changes associated with uncommon disease states. More and more women are presenting with high risk pregnancies that involve multiple co-morbidities that previously prevented successful pregnancy and parturition. These unusual disease states require the anesthesiologist to become cognizant of unique presentations and to be able to adapt easily to difficult situations.
This case report will describe the unusual events that led to the untimely death of a 28-year-old parturient. WM was a 28-year-old Gravida 2 Para 1001 patient that presented to the Obstetric Anesthesia service at 33 weeks gestational age for elective Cesarean section. Indication for Cesarean section was intrauterine growth restriction. The patient had a history significant for Systemic Lupus Erythematosis, lupus nephritis, systemic hypertension, a previous bout of pneumonia with ICU admission, chronic steroid use, and albinism. At the time of C-section our junior resident also noticed an erythematous area localized in the upper anterior thigh and groin area. Our patient had an uncomplicated Cesarean section for which our OB Anesthesia service placed a Continuous Spinal Epidural as per protocol and uneventful course.
In the early hours of the morning on what would be post-operative day number 3, the patient suffered a cardiac arrest followed by a trip to the operating room subsequently for exploration of the abdomen and possible debridement of the suspicious rash. The patient received blood transfusions and vasopressor therapy. Unfortunately she passed away post-operatively due to unknown causes.
This case brings together multiple medical conditions that could have led to this unfortunate death, and offers many opportunities to discuss possible management strategies. Although the management of patients with SLE has been previously studied, seldom does one see a patient with such significant disease and rapid deterioration.