MELAS syndrome (mitochondrial encephalopathy, lactic acidosis, and stroke-like symptoms) is a rare and complex mitochondrial disorder. We present the in-hospital course of a 36-year-old gravida 2, para 0 with MELAS syndrome and severe preeclampsia, complicated by hyponatremia, hyperkalemia, and diabetes. A retained placenta with postpartum hemorrhage required urgent instrumental delivery under spinal anesthesia, transfusion, and intensive care unit admission for pulmonary edema, effusions, and atelectasis. Postpartum endometritis and sepsis also were encountered. This is to our knowledge the first case report of obstetric complications in MELAS syndrome and highlights the salient metabolic sequelae of this syndrome.
Neuraxial anesthesia is a gold standard anesthetic technique employed for labor analgesia and cesarean section. Spinal cord injury can occur if the needle insertion is performed above the recommended lumbar spine level. Pre-procedural lumbar spine ultrasound scanning can provide several benefits, such as increasing first attempt success rate, reducing the number of attempts, and reducing redirection of the needle. Pulmonary aspiration during general anesthesia is a fatal complication which remains a cause of maternal mortality. Gastric content volume (GCV) is an important component related to the risk of regurgitation followed by aspiration. There is growing interest in the utility of bedside gastric ultrasound to assess GCV in non-obstetric and obstetric populations.
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