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JAUNDICE COMPLICATING PREGNANCY ?HELLP

JAUNDICE COMPLICATING PREGNANCY ?HELLP. Dr.SELVAPRIYA. 27 Yr old Mrs.Amutha was referred from kuttakuzhi PHC with h/o PIH with jaundice for past two days Patient had regular check up at the same PHC LMP 30/10/2012 EDD 7/08/2013. H/O PRESENTING ILLNESS.

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JAUNDICE COMPLICATING PREGNANCY ?HELLP

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  1. JAUNDICE COMPLICATING PREGNANCY?HELLP Dr.SELVAPRIYA

  2. 27 Yr old Mrs.Amutha was referred from kuttakuzhi PHC with • h/o PIH with jaundice for past two days • Patient had regular check up at the same PHC • LMP 30/10/2012 • EDD 7/08/2013

  3. H/O PRESENTING ILLNESS • patient was diagnosed to have PIH for the past three days and was on tab Aldomet since then • All the three trimesters were unevenful

  4. Menstrual &marital history • Normal cycle • 3/28 • Married since 2years • Non consanginous marriage

  5. EXAMINATION • Patient • Afebrile • Icteric • Bilateral pedal edema BP 140/100 mm hg Pulse90/min

  6. PER ABDOMEN • Uterus • term • Cephalic Not acting • FH good PV Cxuneffaced OS CLOSED PPVX 3 Pelvis adequate

  7. INVESTIGATIONS • HB 10.4 gm% • Tc 14600 cells/cu.mm • DC 71% L 22% E 7% • PLATELET 1.2 Lakhs • PCV 32 • SERUM URIC ACID 6.2 mg/dl • UREA 27 mg/dl • CREATININE .79 mg/dl

  8. Lft • SerBilurubin 9.6 mg/dl • Dir Bilirubin 6.6mg/dl • In Bilirubin 3mg/dl • SGOT 42IU/L • SGPT 55IU/L • Serum Alkaline phosohate 122 IU/L • Total protien 6.8g/dl

  9. URINE • ALBUMIN ++ • SUGAR NIL • DEPOSIT 4 TO 6 PUS CELLS

  10. Viral panel was negative • Leptospira negative • Dengue negative • Malaria negative • Prothrombin time • test 11.4 • Control 9.8 INR 1.16

  11. APTT • T 38 • CONTROL 28 FIBRINOGEN 200

  12. Patient was given two pints of fresh frozen plasma. • Emergency ultra sound • 36 TO 37 weeks • SLIUF • Severe oligohydraminos • AFI 3 • Mild hepatomegaly • Mild ascitis

  13. Inj MgSO4 was started immediately on admmission and patient was taken for emergency ceserean section at 10 pm.Delayed to obtain all investigations and rule out all viral cause.baby was thick meconium stained.A live male baby apgar 7.10

  14. Patient had a severe BP fall after the delivery and uterus was severlyatonic.but there was no bleeding .hence B lynch was done and abdomen was closed after inserting the drain in the peritonium.

  15. Postoperatively the BP WAS 120/90 mm hg • From the 2nd post op the patient had severe abdominal distension • Ultra sound taken showed mild ascitis with pleural effusion

  16. SerBilurubin5.8mg/dl • Dir Bilirubin 3mg/dl • In Bilirubin 2.8mg/dl • SGOT 39IU/L • SGPT 50IU/L • Serum Alkaline phosohate125 IU/L • Total protien6.7 g/dl • Platelet 1.5 • Urine albumin ++ • Repeat dengue negative

  17. Ascitic tapping done • Ascitic fluid protien .38 mg/dl • Asciticfluid glucose 94 mg/dl • Asciticfluid chloride3 99.7 mg/dl • Cell cunt 21 leukocyte /cu.mm

  18. Distension settled with post op Lasix and the patient was discharged on the 8th post op day and the baby was fine.

  19. THANK YOU

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