Massive Ascites and Pleural Effusion in Preeclampsia

Abstract

A 27-year-old primigravid female was referred to our clinic with severe preeclampsia at 35 weeks of gestation. Her medical history was uneventful. She was administered 1000 mg/day alphamethyldopa since, 28 weeks of gestation. On admission, her blood pressure was 180/ 110 mmHg and urinary albumin 2+. Complete Blood Count (CBC) was in normal limits. Her serum biochemical analysis revealed: ALT: 401 U/L, AST: 292 U/L, creatinine: 1.39 mg/dL, urea: 40 mg/dL (16.6-48.5), uric acid: 8 mg/dL (2.4-5.7), total protein: 6.25 g/dL (6.4-8.3) and albumin: 3.3 g/dL (3.5-5.2). Her coagulation profile was within normal limits. A single live fetus of 31 weeks gestation along with 85 mm amniotic fluid index was detected by USG. Colour flow doppler USG revealed increased umbilical artery resistance. There were no subjective symptoms such as headache, epigastric pain and visual symptoms. Late decelerations were detected on cardiotocography trace and she was diagnosed to have fetal distress. An emergency cesarean section was performed and 1450 gm male fetus was delivered with APGAR score of 8/10. Postoperatively, she was given amlodipine 20 mg/day. Her blood pressure recordings were within normal limits. On first postoperative day 20-30 cc/hour urine output was detected. Serum transaminases were lowered. On the second postoperative day, she had abdominal distension and Massive Ascites and Pleural Effusion in PreeclampsiaKeywords: Hypertension, Peritoneal effusion, Pregnancy ABSTRACTPreeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation and complicates approximately 2-8% of all pregnancies. Release of vasoconstrictive agents, endothelial damage, hyperpermeability of the capillaries and microangiopathic haemolysis involves the basic pathophysiology. It has variable clinical presentation. Here, we report a case of severe preeclampsia who developed postpartum massive ascites and pleural effusion. Primigravid patient was admitted to our clinic at 35 weeks of gestation with very high blood pressure. In biochemical analysis, Alanine aminotransferase (ALT) was 401 U/L, Aspartate aminotransferase (AST) was 292 U/L. An emergency caesarean section was performed because of fetal distress. On the 2 nd post-operative day, abdominal distension and severe abdominal pain occurred. On the 3 rd post-operative day, her abdominal distension increased and Ultrasonography (USG) revealed massive ascites. Abdominal drainage was performed and albumin infusion was administered. On postoperative day 4, she still had abdominal distension and concomitant respiratory distress. Computed Tomography (CT) showed ascites and bilateral pleural effusion. Her complaint regressed on the following days.severe abdominal pain. The USG showed minimal ascites fluid. CBC was normal and serum albumin level was 2.5 gm/dl. Serum sodium level was normal. She had 320 µg albumin/mg creatinine (albumin:creatinine ratio) on spot urine sample. On the 3 rd postoperative day, her abdominal distension increased and USG revealed massive ascites. Abdomi...

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“…Caused positive effect in a patient with severe PE complicated with postpartum massive ascites and pleural effusion [76] Heparin Maintains the eGC thickness, inhibits neutrophil adherence and inflammation [77] Is effective in PE and concomitant inherited or acquired thrombophilias [78]. According to meta-analysis, LMWH does not seem to reduce the risk of recurrent placenta-mediated pregnancy complications in at-risk women [79].…”

A case of preeclampsia developing massive ascites after delivery

“…In their case, acute postpartum ascites was quite predominant to pleural effusion. They concluded that the cause of massive ascites in the postpartum period is difficult to identify; however, the obstetrician must pay attention to severe preeclampsia associated with massive ascites in postpartum 11 . Although we also do not know the exact reason for the predominant massive ascites accumulated in postpartum, elevated intra‐abdominal pressure (IAP) in antepartum may be a key physiological component for resolving this issue.…”

“…They concluded that the cause of massive ascites in the postpartum period is difficult to identify; however, the obstetrician must pay to severe preeclampsia associated with massive ascites in postpartum. 11 Although we also do not know the exact reason for the predominant massive ascites accumulated in postpartum, elevated intra-abdominal pressure (IAP) in antepartum may be a key physiological component for resolving this issue. Chun and Kirkpatrick 12 describe how term pregnancy and immediate postpartum phases may be associated with elevated IAP, which drops significantly after delivery.…”

A Case of Preeclampsia with Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage

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