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.