[Patient with postpartum seizures: differential diagnosis].
Pre-eclampsia is a serious obstetric complication associated with a high rate of maternal and fetal morbidity and mortality. We report the case of a woman with a medical history of insulin-dependent diabetes mellitus and seizures possibly related to hypoglycemia who was admitted for an emergency cesarian due to severe pre-eclampsia and macrosomic fetus. In the first hour after delivery she experienced loss of consciousness and seizure, with vaginal bleeding and hypovolemic shock. Maximum vigilance is required for a patient with several concomitant diseases and a high-risk pregnancy. All prophylactic measures to lower the risk to mother and fetus should be undertaken. We analyze preanesthetic assessment, differential diagnosis, and choice of anesthesia in relation to this case.
Higueras
R
R
Servicio de Anestesiología y Reanimación, Hospital Universitario Doctor Peset Aleixandre, Valencia.
Beltrán
M
M
Peral
D
D
Ferrándiz
L
L
Barrachina
C
C
Barberá
M
M
D000328:Adult; D002585:Cesarean Section; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003937:Diagnosis, Differential; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis; D004630:Emergencies; D004827:Epilepsy / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005320:Fetal Macrosomia; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D007044:Hysterectomy; D007231:Infant, Newborn; D010121:Oxytocin / Q000627:therapeutic use; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011247:Pregnancy; D011248:Pregnancy Complications; D011254:Pregnancy in Diabetics; D018566:Pregnancy, High-Risk; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000209:etiology; D012769:Shock / Q000209:etiology; D020521:Stroke / Q000175:diagnosis; D014592:Uterine Hemorrhage / Q000150:complications
D010121:Oxytocin