ABSTRACT
The classic indication for prescribing dietary sodium restriction in pregnancy has been the prevention of eclampsia. We describe a case of intrapartum eclampsia in a 24-year-old nulliparous woman. A strongly sodium restricted diet was prescribed because of pre-eclampsia. Compliance to the diet was checked with 24-hour urinary sodium excretion. This report, describing the first case of eclampsia despite neglectable urinary sodium excretion, adds to the view that sodium restriction in pregnancy is obsolete.
Subject(s)
Diet, Sodium-Restricted , Eclampsia/prevention & control , Adult , Anticonvulsants/therapeutic use , Eclampsia/diagnosis , Female , Humans , Pre-Eclampsia/diet therapy , Pregnancy , Pregnancy Outcome , Seizures/drug therapy , TwinsABSTRACT
A 36 year old woman with left heart failure and right-sided hemiparesis due to endocarditis of the aortic valve underwent urgent aortic valve replacement during the 24th week of gestation. High-flow high-pressure normothermic perfusion during cardiopulmonary bypass was performed. Peri-operative fetal heart rate and uterine contractions were monitored. Severe fetal heart rate decelerations and loss of variability as well as uterine contractions were observed during surgery. Uterine contractions were treated medically. Pregnancy was carried to term and a healthy baby was delivered vaginally. The effect of the nonpulsating cardiac pump during extracorporeal circulation on the fetus will be discussed. Recommendations for the peri-operative management of the fetal unit are made.
Subject(s)
Aortic Valve Insufficiency/surgery , Arrhythmias, Cardiac/etiology , Endocarditis/complications , Fetal Diseases/etiology , Heart Rate, Fetal , Intraoperative Complications , Pregnancy Complications, Cardiovascular/surgery , Adult , Aortic Valve Insufficiency/etiology , Arrhythmias, Cardiac/physiopathology , Electrocardiography , Female , Fetal Diseases/physiopathology , Humans , Pregnancy , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Trimester, SecondABSTRACT
Cross-clamping of the descending thoracic aorta for surgical correction of coarctation carries a risk of injury to the spinal cord, which is usually attributed to insufficient blood supply along the spinal arteries. To detect inadvertent interruption of spinal cord perfusion, lumbar pressure was monitored during operation on the aorta in eight patients. One patient incurred ischemic damage of the spinal cord, resulting in paraparesis. In this patient, spinal fluid pressure increased to such high levels that it may have caused tamponade of the cord. The pressure increase resulted from expansion of cerebral vessels caused by an acute rise of arterial pressure after clamping, probably aggravated by the administration of a vasodilating drug. During operations in which the circulation of the spinal cord is compromised long enough to cause ischemic damage, the femoral artery and spinal fluid pressures should be monitored. If the pressure difference between femoral artery and lumbar cavity drops to a dangerously low level, a shunting procedure should be performed.
