Lightning strikes thrice

ABSTRACT

Introduction: A case of multiple co-existing conditions during pregnancy in a previously fit and well individual. Case Report A 24-year-old woman presented at 37 weeks during her second pregnancy with a five day history of vomiting and abdominal pain. She had no significant past medical history. Her oxygen saturations were low so she received treatment for aspiration pneumonia. Her initial COVID-19 antigen test was negative however subsequent PCR was positive. The cause of her acute abdomen was unclear, with the differentials being perforated duodenal ulcer, pancreatitis and appendicitis. With input from general surgery, obstetrics and anaesthesia a decision was made to proceed with a diagnostic laparotomy. Classical caesarean section was performed at the beginning of the procedure. A healthy baby was delivered and laparotomy revealed pancreatitis. Due to high intraoperative oxygen requirements, shewas kept intubated and transferred to intensive care post operatively. An echocardiogram revealed biventricular failure and she was commenced on treatment for peripartum cardiomyopathy. Overall, she remained intubated for nine days andwas discharged from hospital 16 days following her surgery. Followup echocardiogram four months after hospital discharge showed her left ventricular ejection fraction remained <35%. Discussion: COVID-19 is increasingly common these days so it is likely to co-exist with other conditions. The incidence of acute pancreatitis during pregnancy is approximately one in 3000 and the incidence of peripartum cardiomyopathy is also approximately one in 3000 in the western world [1,2]. This case serves as a reminder that multiple conditions may be present in one individual and highlights the importance of completing a full set of investigations. This patient had multiple reasons for respiratory failure, however, an echocardiogram was necessary to reveal peripartum cardiomyopathy. Her ejection fraction remains low which puts her at high risk of mortality for future pregnancies. However, this diagnosis has allowed her to receive the appropriate follow up and counselling.