Acute Fulminant Eclampsia with Cardiopulmonary arrest, Pulmonary Oedema and PRES: Maternal and Fetal Outcome

Abstract

Complicated eclampsia resulting in cardiac arrest and subsequent fetal and maternal survival is rare. A 25-year-old primigravida was referred after initial resuscitation for cardiac arrest following a maternal collapse during pregnancy due to eclampsia at 36 weeks of pregnancy. The diagnosis at referral was antepartum eclampsia, pulmonary oedema and intrauterine fetal death. Re-evaluation revealed presence of fetal cardiac activity on ultrasound and an immediate emergency Caesarean Section was carried out and a live baby with APGAR of 3/10 was delivered and cared for in neonatal intensive care unit after intubation and positive pressure ventilation. Mother was managed in obstetric intensive care unit and was on ventilator for 72 h. She was treated for pulmonary oedema and persistent hypertensive crisis requiring multiple antihypertensives including nitroglycerine. Her echocardiogram showed global hypokinesia and left ventricular ejection fraction of 45% on day 1 which later improved to normal by day 15. MRI brain showed features of posterior reversible encephalopathy syndrome. She was given levitricetam for seizure prophylaxis. In addition, she required treatment for aspiration pneumonia. She was discharged after 16 days on two antihypertensive drugs along with her baby in good health. Timely resuscitation following cardiac arrest and transport to a tertiary care centre and control of hypertensive crisis with multidisciplinary care were the life-saving factors in this case.