title: Multidisciplinary Approach to Complicated Pregnancy.
abstract: A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic. On the ninth day postadmission, however, her condition abruptly deteriorated and advanced to imminent eclampsia, accompanied by transient vision loss, altered mental status, and acute hypertensive crisis. After the patient underwent successful emergent delivery via caesarean section, a laboratory workup revealed hemolysis, elevated liver enzymes, and low platelet count, suggesting HELLP syndrome, a serious complication of eclampsia. This patient concurrently developed posterior reversible encephalopathy syndrome, which was confirmed by magnetic resonance imaging and acute respiratory distress syndrome (the latter presented with diffuse bilateral infiltrates on x-ray and developing pulmonary edema in the absence of cardiac etiology). Because of these life-threatening dynamics, the patient was transferred to the intensive care unit for further treatment. This case is a rare cascade of life-threatening complications that developed in a patient and required skillful multidisciplinary decision making and experienced management within an acute critical care setting. The final outcome of the treatment and intensive care was successful because both the patient and child survived and had no chronic or debilitating sequelae.
authors.affiliation: From the Department of Pathophysiology, University of Split School of Medicine, Split, the Department of Internal Medicine, University Hospital Center Split, Split, University Psychiatric Hospital Vrapce, University of Zagreb School of Medicine, Zagreb, the Clinical Department of Diagnostic and Interventional Radiology University Hospital Center Split, Split, and the Department of Gynecology and Obstetrics, University Hospital Center Split, Split, Croatia.
authors.forename: Josip Andelo
authors.initials: JA
authors.lastname: Borovac
authors.affiliation: From the Department of Pathophysiology, University of Split School of Medicine, Split, the Department of Internal Medicine, University Hospital Center Split, Split, University Psychiatric Hospital Vrapce, University of Zagreb School of Medicine, Zagreb, the Clinical Department of Diagnostic and Interventional Radiology University Hospital Center Split, Split, and the Department of Gynecology and Obstetrics, University Hospital Center Split, Split, Croatia.
authors.forename: Josko
authors.initials: J
authors.lastname: Bozic
authors.affiliation: From the Department of Pathophysiology, University of Split School of Medicine, Split, the Department of Internal Medicine, University Hospital Center Split, Split, University Psychiatric Hospital Vrapce, University of Zagreb School of Medicine, Zagreb, the Clinical Department of Diagnostic and Interventional Radiology University Hospital Center Split, Split, and the Department of Gynecology and Obstetrics, University Hospital Center Split, Split, Croatia.
authors.forename: Tina
authors.initials: T
authors.lastname: Ticinovic Kurir
authors.affiliation: From the Department of Pathophysiology, University of Split School of Medicine, Split, the Department of Internal Medicine, University Hospital Center Split, Split, University Psychiatric Hospital Vrapce, University of Zagreb School of Medicine, Zagreb, the Clinical Department of Diagnostic and Interventional Radiology University Hospital Center Split, Split, and the Department of Gynecology and Obstetrics, University Hospital Center Split, Split, Croatia.
authors.forename: Nikola
authors.initials: N
authors.lastname: Zaja
authors.affiliation: From the Department of Pathophysiology, University of Split School of Medicine, Split, the Department of Internal Medicine, University Hospital Center Split, Split, University Psychiatric Hospital Vrapce, University of Zagreb School of Medicine, Zagreb, the Clinical Department of Diagnostic and Interventional Radiology University Hospital Center Split, Split, and the Department of Gynecology and Obstetrics, University Hospital Center Split, Split, Croatia.
authors.forename: Kresimir
authors.initials: K
authors.lastname: Kolic
authors.affiliation: From the Department of Pathophysiology, University of Split School of Medicine, Split, the Department of Internal Medicine, University Hospital Center Split, Split, University Psychiatric Hospital Vrapce, University of Zagreb School of Medicine, Zagreb, the Clinical Department of Diagnostic and Interventional Radiology University Hospital Center Split, Split, and the Department of Gynecology and Obstetrics, University Hospital Center Split, Split, Croatia.
authors.forename: Vedran
authors.initials: V
authors.lastname: Hrboka
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019575:Blindness, Cortical / Q000209:etiology; D003221:Confusion / Q000209:etiology; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D020343:Hypertensive Encephalopathy / Q000000981:diagnostic imaging / Q000209:etiology; D007442:Intubation, Intratracheal; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging; D008278:Magnesium Sulfate / Q000627:therapeutic use; D010348:Patient Care Team; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000628:therapy*; D011247:Pregnancy; D012128:Respiratory Distress Syndrome / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D000959:Antihypertensive Agents; D008278:Magnesium Sulfate