A case of a pregnant woman with eclampsia emergently treated for hematemesis and consciousness disorder

Abstract

 A 35-year-old pregnant woman（G1P0, 35 weeks and 3 days）was admitted to our hospital for hematemesis and consciousness disorder. Vital signs during admission were as follows: body temperature, 36.6℃; heart rate, 161 bpm; blood pressure, 182/130 mmHg; respiratory rates, 35 /min, SpO2, 99%（15 L/min with a non-rebreather mask）; and Glasgow coma scale, E4V4M6. The fetal heart rate was 70–100 bpm, indicating a non-reassuring fetal status. The patient had a tongue bite and stomatorrhagia, but no bleeding presented with gastric lavage. Venous blood gas data showed pH, 6.94 and Lac, 170 mg/dL, and the urine protein was 4+. The patient was diagnosed with consciousness disorder due to eclampsia, stomatorrhagia due to tongue bite, and non-reassuring fetal status due to maternal and fetal hypoxia resulting from convulsion. After administering nicardipine and magnesium sulfate, both the maternal vital signs and fetal status improved. However, due to prolonged disorder of maternal consciousness, we performed an emergency cesarean section under general anesthesia. The birth weight of the infant was 2,260 g, and the Apgar scores were 1 at 1 min and 6 at 5 min. The infant was premature and admitted to Neonatal Intensive Care Unit（NICU）. The patient was discharged on day 11 of postoperation, with no further symptoms after discharge. The infant was discharged at 18 days of age, and no physical growth and developmental disorders were observed 1 year and 4 months after birth.