Emergency cesarean section combined with multidisciplinary critical care successfully managed concurrent eclampsia, HELLP syndrome, and peripartum cardiomyopathy, improving ejection fraction to 58%.
Case Report (n=1)
No
This case highlights the diagnostic overlap between preeclampsia-spectrum pulmonary edema and peripartum cardiomyopathy, emphasizing the value of bedside echocardiography and multidisciplinary care.
Hypertensive disorders of pregnancy can rapidly progress to multi-organ failure. Eclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome are obstetric emergencies, while peripartum cardiomyopathy (PPCM) is a rare but potentially fatal cause of heart failure in late pregnancy and the postpartum period. We report the case of a critically ill 32-year-old primigravida at 35 weeks’ gestation with treated hypothyroidism who presented with generalized tonic-clonic seizures, severe hypertension, and pulmonary edema. Laboratory evaluation demonstrated thrombocytopenia and transaminitis with markedly elevated lactate dehydrogenase (LDH), consistent with HELLP syndrome. Obstetric assessment revealed a closed cervical os with the vertex above the brim, and bedside ultrasound confirmed a viable fetus with good cardiac activity and no evidence of placental abruption. Targeted echocardiography showed global left ventricular hypokinesia with severe systolic dysfunction (estimated ejection fraction ~25%) and a dilated left ventricle with moderate (grade II) mitral regurgitation and diastolic dysfunction. After stabilization with airway protection, magnesium sulfate, antihypertensive therapy, diuretics, and inotropic support, an emergency lower-segment cesarean section was performed, resulting in the delivery of a live female baby. Postoperatively, the patient required intensive care, blood product transfusion for HELLP syndrome, and guideline-directed heart failure therapy. Serial echocardiography showed improvement in ejection fraction to 45% on postoperative day two and 58% before discharge. This report underscores the diagnostic overlap between preeclampsia-spectrum pulmonary edema and PPCM, and highlights the role of bedside echocardiography and multidisciplinary critical care in optimizing maternal outcomes.
Anbu et al. (Fri,) conducted a case report in Concurrent Eclampsia, HELLP Syndrome, and Peripartum Cardiomyopathy (n=1). Emergency cesarean section and multidisciplinary critical care was evaluated on Clinical recovery and improvement in left ventricular ejection fraction. Emergency cesarean section combined with multidisciplinary critical care successfully managed concurrent eclampsia, HELLP syndrome, and peripartum cardiomyopathy, improving ejection fraction to 58%.