tailieunhanh - Case lâm sàng sản khoa - Case 7

Tham khảo tài liệu 'case lâm sàng sản khoa - case 7', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 25 A 19-ycar-old i 1 PO woman at 29 weeks gestation has severe preeclampsia with several blood pressures of 160 110 and 4 proteinuria. She denies headaches or visual abnormalities. She notes a 2-day history of severe unremitting epigastric tenderness. The patient s platelet count was 130 000 mL hemoglobin level is 13 mg dL and SGOT is 2100 mlU mL nL 35 . Shortly after admission she received intravenous magnesium sulfate and was induced with oxytocin. She delivered vaginally. Two hr after delivery the patient complains of the sudden onset of severe abdominal pain and has a syncopal episode. The patient is found to have a blood pressure of 80 60 a distended abdomen and heart rate of 140 bpm with a thready pulse. What is the most likely diagnosis What is your next step 210 CASE FILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 25 Preeclampsia and Hepatic Rupture Summary A 19-ycar-old Gl PO woman who delivered at 29 weeks gestation is noted to have severe preeclampsia epigastric tenderness and markedly elevated liver function tests. Shortly after delivery she develops sudden severe abdominal pain abdominal distension syncope hypotension and tachycardia. Most likely diagnosis Hepatic rupture. Next step Emergent exploratory laparotomy and blood product replacement. Analysis Objectives 1. Know the clinical presentation of preeclampsia. 2. Know the serious sequelae of severe preeclampsia including hepatic rupture. 3. Understand that immediate laparotomy and massive blood product replacement are important in the management of hepatic rupture. Considerations The patient is nulliparous which is a risk factor for preeclampsia. She has severe prccclampsia based on blood pressure criteria proteinuria epigastric tenderness and elevated liver function tests. The epigastric tenderness occurs because of the ischemia to the liver. Rarely a hepatic hematoma may form and if rupture of the hematoma occurs catastrophic hemorrhage can ensue leading to rapid exsanguination if immediate