Hellp with di
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Transcript of Hellp with di
Twin pregnancy with HELLP SYNDROME with DIABETES
INSIPIDUS
Case Presentation
By - Dr.Manjushree BoobM.B.B.S.,M.D.,D.N.B.,F.I.C.M.C.H.
FELLOWSHIP LAPAROSCOPIC SURGERY & INFERTILITY [FRANCE]
Dr. Saima Khan [D.R.C.H. Student]Dr.Shweta Soni [D.R.C.H. Student]
MRS. PT 24YRS. 3RD GRAVIDA WITH TWIN PREGNANCY CAME AT 34 WEEKS FOR ANC
CHECKUP O/E : G.C. Better Affebrile No Pallor Oedema ++ Rs/cvs-Normal P/A-ut.OD Mfp +nt Both FHS reg.140/mins
Presentation 1st Vertex 2nd Breech
B.P 160/110mm/hg DTR +nt
Adv:PIH profile Admission
She came with mild headache nausea
Her BP was 160/110
Oedema+++
Got immidiately admitted
PIH profile done
INVESTIGATION
HB-8.5gm% Bld group- AB+ve Haematocrit-30.0 MCV-100.0 MCH-28.3 TWC-8,800 S.G.O.T-70
SERUM LDH-361 KFT: serum creatinine-1.10 serum sodium-142 serum potassium 3.3 serum ionised calcium-
1.1
MANAGEMENT Inj mgso4 4gm loading dose given after checking DTR
RR was 18/min
Output in last 4hr was more then 400ml.
Pt already on Tab Labetelol tds.
Tab. Nicardia 2mg BD started
BP & FHS monitoring maintained
After 6 hrs she had developed suttle convulsion & had a fall.
Reports of PIH profile had come and was suggestive of HELLP.
Immidiately shifted to OT for emergency LSCS after explaining all risk &complication to relatives.
Pt operated under SA
Lscs done 1st baby by vx and 2nd by breech.
Both females weight 2.3kg and 2.1kg cried immediately.
No PPH,no cyanosis
I/O uneventfull.
POSTOPERATIVE MANAGEMENT Pt.had I/O output of1500ml&then in 24hrs output were 5500ml.
Physician was consulted.
Strict intake and output chart was maintained
24hrs output was 6-7liters.
Daily KFT ,Serum eletrolytes and urine specific gravity was seen .
Pt managed conservativly till d-4.
But as output was always more then 6liters.
Nasal vasopressin spray was given and in 2 doses 4 hrs apart she responded completely.
Pt was discharged on D-8 in absolute healthy condition and good suture line.