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PCP and Preeclampsia in the Parturient: A Recipe for Intracranial Hemorrhage and Hemodynamic Instability
Abstract Number: F-47
Abstract Type: Case Report/Case Series
Background: Intracranial hemorrhage (ICH) affects 4.3/100,000 pregnancies , with an increased risk in the setting of preeclampsia . Phencyclidine (PCP) is also a known cause of hemorrhagic stroke, possibly due to its hypertensive effect  and by weakening the walls of cerebral arterial vasculature . ICH can result in hemodynamic instability and complications for the parturient, especially in the peripartum period.
Case: We present a 39 year old morbidly obese G6P2 parturient at 33 weeks gestation transferred to our institution with a PMH of chronic hypertension, no prenatal care and a drug screen positive for PCP and benzodiazepines. The patient presented to the outside hospital with sudden-onset left-sided weakness, headache, and diplopia. Her blood pressure was 258/120, and labs confirmed a diagnosis of preeclampsia. CT of the head demonstrated an acute thalamic ICH, measuring 1.6 x 1.1cm. Anti-hypertensive and magnesium infusions were initiated and transfer to our hospital was requested. Our transport team noted repetitive late decelerations on the FHT, and immediate delivery was recommended. The transferring hospital refused to deliver the fetus, and, the patient was transferred to our institution. Upon arrival, the patient was also tachypneic, dyspneic, and could not lie flat. A radial arterial line was placed and an emergent caesarean delivery was performed under general anesthesia. Although induction of anesthesia and endotracheal intubation were uneventful, following delivery of the fetus, the patient developed prolonged hemodynamic instability with hypotension and bradycardia to the 30s, requiring boluses of epinephrine and a phenylephrine infusion. After a prolonged recovery, the patient was discharged to a rehabilitation facility on PPD 11 with improved neurologic function.
Discussion: The combination of preeclampsia and PCP use may create an increased risk of intracranial hemorrhage in the parturient. The emergent nature of the fetal delivery complicated the management of the patient’s ICH which has sequelae of cardiac failure and hemodynamic lability. When caring for parturients with ICH in the peripartum period, providers should prepare for marked hemodynamic instability.
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