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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Cesarean section for a patient with severe preeclampsia,morbid obesity and rapidly worsening pneumonia

Abstract Number: F 77
Abstract Type: Case Report/Case Series

Sumita Bhambhani M.D.1 ; Scott Levin D.O.2

Severe preeclampsia during pregnancy can present numerous challenges to both the obstetrician and the anesthesiologist. Compounding problems like rapidly progressing bilateral lobar pneumonia and morbid obesity can make the management of these patients a daunting task. We present here the case of a 33 years old female 29 weeks pregnant with severe preeclampsia who presented to labor and delivery with one week history of worsening shortness of breath, productive cough with fever, and substernal chest pain. Given her strong family history of thromboembolism, she was admitted to the hospital with a working diagnosis of pulmonary embolism and a heparin infusion was started empirically. Spiral CT scan of the chest did not exhibit any evidence of pulmonary embolism. Chest X Ray showed retrocardiac consolidation bilaterally with para bronchial cuffing suggestive of pneumonia. A transthoracic echocardiogram showed an ejection fraction around 60-65%. An ultrasound showed the fetal presentation to be breech. On examination, the patient was a very pleasant Hispanic female, with a height of 5 feet, and she weighed 290 pounds. She had a short thick neck and her airway exam was Mallampati 3, with a large tongue. After admission, her oxygen requirement increased steeply as her pneumonia worsened and she experienced difficulty lying flat. She had a history of a prior cesarean section done at an outside hospital. In view of her worsening condition, and the fact that she had been receiving betamethasone for fetal lung maturity, the plan to deliver her baby by cesarean section was made. The heparin infusion was stopped 12 hours prior to surgery. The patient expressed a strong desire not to be intubated. She was kept on 10 liters of oxygen with aquanox. Since heparin infusion had been stopped and her last dose of subcutaneous heparin was 12 hours ago, the plan to perform an epidural block for cesarean section was made. Two large bore intravenous lines were placed preoperatively. The epidural catheter was incrementally dosed with 2%lidocaine with 1:200,000 epinephrine until a T4 level was achieved.The patient was placed in twenty degrees head up position throughout the procedure. The oxygen supplement with 10 liters of oxygen with aquanox was continued throughout the procedure. The baby delivered was immediately transferred to the neonatal intensive care unit for further management. The patient had a smooth intraoperative course and continued to improve postoperatively. Her oxygen requirements decreased substantially and she was discharged home with 2 liters of oxygen via nasal cannula on post operative day 6.

SOAP 2013