Browsing by Author "Salazar Lizano, Darío Israel"

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    “Síndrome de hellp completo, secundario a preeclampsia grave”
    (Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Salazar Lizano, Darío Israel; Dr. Córdova Peñaloza, Opilio
    This case is about a 22-year-old female patient with no relevant pathological history who is taking her first pregnancy (34 weeks), is treated in Emergency on 06/02/2017 for presenting approximately 24 hours before her admission Holocranial headache of moderate intensity accompanied by scotomas, espigastralgia and about 12 hours ago decrease her fetal movements, so go to a private doctor who recommends going to Provincial Ambato Hospital. Is evaluated in Emergency who decide her hospitalization to Gynecology and Obstetrics service with a diagnosis of Tonsillitis + Pregnancy of 33.5 weeks + Fetal Bradycardia Upon admission to Obstetrics and Gynecology, a patient is received with SCORE MAMA 4 without a strip, Arterial Blood Pressure: 100/60, Heart Rate: 74 bpm, Respiratory Rate: 22 rpm, Saturation: 94%, ultrasound scan, finding a single fetus, transverse , cephalic pole to the right, upper back, posterior fundic placenta Grade III, absence of heartbeat, for which they decide termination of pregnancy by high route, procedure that is performed under spinal anesthesia at one and a half hours after admission to obstetrics gynecology. During the procedure, a bladder catheter is placed to assess diuresis, which is not produced, cataloging it in this way with Acute Renal Insufficiency, for this reason Obstetrics Specialists request an assessment by the Intensive Care Unit (ICU), who value the patient and decide on treatment based on hydration and antibiotic therapy. In a new assessment by obstetrics gynecologist the patient is found with hepatic transaminase values and elevated LDH as well as coagulation times, and with alterations in abdominal ultrasound, and for this reason the specialists decided to initiate the protocol of hypertensive disease of pregnancy, Anuria is evidenced and a new assessment is requested by ICU who decide to enter the Intensive Care Unit for management of incomplete HELLP syndrome + renal failure and possible complications (07/02/2017). In intensive care room stayed controlled until 09/02/2017 where it is found that the patient has an increase in the production of each of their drains which were placed during the procedure of cesarean section. TAC Tóraco - Abdominal is performed where the presence of ascitic fluid + bilateral pleural effusion is evidenced, laboratory tests blood count, blood chemistry and EMO were altered and so a medical consensus is made among surgeons, gynecologists and intensivists who decide compensation of dyscrasia blood + anemia + expectant management due to the need for an eventual laparotomy. On 02/12/2017, the patient presented generalized tonic clonic movements, whereby phenobarbital 240 IV STAT was administered, maintaining arterial pressures between 160/100 - 120/70. However, there was an improvement in terms of urine production, as well as examinations of laboratory with slight improvement Patient evolves favorably and after 11 days of hospitalization in the ICU on 02/18/2017, it is decided to discharge and later be treated in the obstetric gynecology ward, presenting the following diagnoses: 1) late puerperium for fetal death, 2) complete HELLP, 3) Severe preeclampsia, 4) Acute hemorrhagic anemia, 5) Coagulopathy, 6) Eclampsia 7) Hepatic failure. In the Gynecology floor, the patient is managed according to the diagnoses given by the ICU by specialist doctors and on 04/03/2017 after 31 days of hospitalization and having been treated until all of her pathologies are resolved she is discharged