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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Nephrotic Syndrome with Superimposed Preeclampsia in a Preterm Parturient

Abstract Number: 258
Abstract Type: Case Report/Case Series

Kalee Salvato MD1 ; Bonny Gillis MD2

This is a 43 year-old Hispanic female G5P0131 with history of poorly controlled diabetes, hypertension diagnosed in 2009 prior to her pregnancy, CML (previously on Gleevac from 2001 to 2009, recently started on Interferon) complicated by left eye blindness in 2001, right hallux amputation for osteomyelitis, gout, and nephrotic syndrome who was admitted from OB clinic for edema, hypertension, and proteinuria with concern for superimposed pre-eclampsia. She was classified as an ASA 4 based on these comorbidities. Review of records showed 2+ proteinuria since 1995. Patient had 3 miscarriages at 6 weeks and 1 PPROM at 31 weeks but denied prior elevation of blood pressure during her previous pregnancies. With regards to her hypertension, patient was diagnosed in 8/09 with BP 140-150/70s, she was initially started on Verapamil 240mg BID and Lasix 40mg BID. Her CML was diagnosed in 01 with remission since 03 which she had been on Gleevec (discontinued on 9/17/09). She had recently been started on Interferon (3 doses starting on Jan 20th) for her CML due to an elevated WBC on labs. She endorsed an allergy to aspirin and sulfa meds( facial edema). Her home medications included verapamil 240mg BID, lasix 40mg BID, lovenox 40mg BID, and insulin. Pt classified as a Mallampati II with no airway issues.

On admission, patient was at 27 3/7 weeks gestation with complaint of lower extremity edema and significant weight gain of approx. 15 lbs over 2 weeks. Manual BP was 160-170/70-80. There was concern for superimposed pre-eclampsia. Pt received a loading dose of Mg and corticosteroids and was admitted for obs. Approximately 12 hrs after admission, blood pressure began to increase, peaking at 222/77. At this time, a left a-line was placed and preparation for a c-section initiated. A Lidco monitor was placed prior to transporting to the OR, at which time her SVR was noted to be 400 and her CO was 13.5. Decision made to proceed with general anesthesia.

This patient had multiple medical problems which influenced her care. The biggest challenge in this patient was volume status secondary to nephrotic syndrome, superimposed preeclampsia and anemia. Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged causing leakage of proteins. Pt had characteristic decreased intravascular blood volume and decreased albumin which was evident by a SVR of 400 and CO of 13.5 by LIDCO. Another contributing factor was the pts Hct of 24. Slow transfusion of blood early was essential to avoid complications of fluid overload such as pulmonary edema. An early intraoperative management plan will be discussed in detail, which provided successful delivery of the fetus and no postoperative complications to mother.

SOAP 2010