In a recent case at 895 bedded Shalinitai Meghe Hospital & Research Centre, Wanadongri, Nagpur, a 24-year-old pregnant woman, at 35 weeks gestation and with a known RH-negative status and Pregnancy-Induced Hypertension (PIH), presented with blurred vision. Due to the critical nature of her condition, an emergency Lower Segment Cesarean Section (LSCS) was performed, resulting in the delivery of a male baby weighing 2.1 kg. Post-surgery, the patient was transferred to the Medical Intensive Care Unit (MICU) at Dr. Babasaheb AmbedkarSuperspeciality Institute, the superspecialty wing of ShalinitaiMeghe Hospital & Research Centre, after experiencing multiple seizure episodes.
The patient received multidisciplinary care under the expertise of Dr. Neha Agarwal (Critical Care Complex Incharge), Dr. Preeti Gattani (Professor- OBGYN), and Dr. Jeevan Kinkar(Neuro Physician). She was diagnosed with HELLP syndrome, characterized by thrombocytopenia, elevated liver enzymes (around 1000 IU/L), and a high International Normalized Ratio (INR) of around 3, alongside elevated Lactate Dehydrogenase(LDH). Initial management included the administration of Anti-D and intravenous anti-epileptic drugs (AEDs). Despite these interventions, the patient continued to experience seizures, eventually progressing to status epilepticus. As a result, she was intubated and placed on a ventilator for airway protection.
Dr. Jeevan Kinkar ensured that a CT brain scan was performed, followed by an MRI, which revealed Posterior Reversible Encephalopathy Syndrome (PRES). Persistent high blood pressure was managed with an intravenous infusion of antihypertensive drugs, and the patient was kept sedated and paralyzed. Multiple blood products were transfused to manage bleeding tendencies, and Vitamin K therapy was initiated. By the evening, bleeding from the nose, mouth, and hematuria was controlled. Oral antihypertensive drugs were introduced to further stabilize blood pressure.
Within a couple of days, the patient’s nutritional support commenced with a feeding tube, and oral antihypertensive medication was adjusted. Intravenous antibiotics were upgraded as needed. An EEG confirmed the absence of ongoing epileptic activity, allowing the cessation of Atracurium and sedation, leading to the initiation of a weaning trial.
Dr. Neha Agarwal ensured that within 5-6 days, the patient was successfully extubated and monitored post-extubation for any recurrence of seizures. She stabilized sufficiently to start a liquid diet, and mobilization began, eventually transitioning to a soft diet. All lab parameters showed gradual improvement, and the patient was eventually shifted to the ward in stable condition, with no neurological deficits or other morbidity. The vigilant care provided by the ICU team effectively prevented severe complications, such as Acute Kidney Injury (AKI), pulmonary edema, and cerebral injury/intracerebral bleed.
Dr. Preeti Gattani explained that HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome is a life-threatening pregnancy complication, often considered a variant of preeclampsia. Both conditions typically occur during the later stages of pregnancy or soon after childbirth. Managing HELLP syndrome, especially with multiple complications, is challenging and often associated with a poor prognosis if not handled appropriately. Early diagnosis is vital because serious illness and even death can occur in about 25% of cases. Therefore, raising patient awareness of HELLP syndrome and its relation to preeclampsia is crucial to ensure the best medical care for both mother and baby.
Dr. Anup Marar- CEO of Healthcare at Meghe Group of Institutions, expressed appreciation for the dedicated and coordinated efforts of the teams led by involved Obstetricians, Neurologists, and Critical Care team at SMHRC/DBASI, which played a crucial role in saving this young woman’s life. This case underscores the importance of teamwork and specialized care in managing complex medical emergencies. He affirmed commitment of Meghe Group to delivering passionate and updated care, heralding a new era of medical excellence in Central India. This is a perfect example of a multidisciplinary approach and great teamwork across all departments.
Dr. Anitabh Sukhdeve, Dr. Samruddhi Tayade, Dr. Rahil, and Dr. Amol, led by Dr. Neha Agarwal, rendered 24/7 critical care support. Br. Sachin and Sr. Jyoti, under the supervision of Sr. Geeta Kubde (ANS) and Nursing Director Seema Singh, provided dedicated nursing care. Additionally, the Pathology and Radiology Departments provided diagnostic support, while the Physiotherapy Department facilitated rehabilitation. Dr. Richa Sharma and Dr. Noorul Ameen effectively managed the administrative operations at the Shalinitai Meghe Mother & Child Block and the Dr. Babasaheb Ambedkar Super SpecialityBlock, respectively.
This uplifting case underscores the significance of timely diagnosis, effective medical care, and supportive nursing, emphasizing the positive impact such elements can have on clinical outcomes. These success stories serve as a driving force for healthcare professionals to continually strive for excellence in patient care.