A 45-year-old woman, madam CB, was referred to our emergency unit on 22 July 2018. The patient was referred on account of eclampsia, acute kidney injury, and HELLP syndrome at 33 weeks gestation.
The patient presented there with complaints of epigastric pain and blurred vision of a day's duration.
She was apparently well until a day prior to presentation when she had the above complaints, which became associated with tonic clinic seizures at home with tongue bite; hence, she was rushed to the hospital. At the hospital, she had another episode of tonic clinic seizures. She was stabilized and referred to KATH for further management. The patient was given antihypertensives and anticonvulsant before referral.
At KATH, the blood pressure was high with proteinuria of 3+; however, the SpO2 was 99% on room air. She looked very unwell, pale, and not jaundiced with good hydration. Her chest was clinically clear. She had epigastric pain. Symphysis-fundal height of 32 cm was consistent with the gestational age. Lie was longitudinal, and presentation was cephalic. Fetal heartbeat was present and normal. No contractions were felt. On pelvic examination, the vulva and vagina looked healthy. The cervical os was closed, and the cervix was 2 cm long, firm, and posterior. The patient had 500 mL of cola-like urine and bedside clotting of 15 min. Impression of eclampsia with HELLP syndrome with an unfavorable cervix was made. The patient had samples taken for FBC, BUE, creatinine, serum uric acid, and grouping and crossmatch for 4 units of whole blood and 8 units of FFP. She was then prepared for emergency CS after the bedside clotting was corrected with transfusion of 3 FFPs. Immediately postop, the patient was very stable with normal vital parameters. 4 h post-CS, the patient had abdominal distension was tympanic, severally pale, and jaundiced. The uterus was well contracted, and shifting dullness was negative. Her pulse was 116 with blood pressure of 164/112 mmHg.
The patient had made 30 mL of cola-like urine in 4 hours. No bleeding per vaginam was noted. She was continued with the haemotransfusion and the FFP, but unfortunately, her condition did not improve and she ceased breathing. Cardiopulmonary resuscitation was attempted for over 30 min but was unsuccessful; hence, she was declared dead. Her labs came later, and liver indices were all markedly raised.